关于我国普外腹腔镜手术的发展课件

1、我国普外腹腔镜手术的发展北京大学第一医院普外科刘国礼初期阶段1991-1994 起步略晚，进展较快。 1991,2 腹腔镜胆囊切除术 1993 腹腔镜胃切除、结肠切除、胆总管切开取石 1994 腹腔镜肝切除、脾切除 启动快的原因人的因素 对腹腔镜手术的反应敏感，认识和承认它的优点，积极热情，愿为发展腹腔镜手术而尽力。在腹腔镜的发展过程中克服多种困难，成为推进我国腹腔镜发展的骨干。腹腔镜手术确有微创优点公司的支持停滞阶段1995-1999 医院增多，手术种类减少原因 技术不成熟，中途放弃 结肠癌术后伤口种植 缺乏有效的和适用的器械 公司支持减少 国民经济尚不充裕大发展 1999- 第一届外科周介

2、绍和认识了腹腔镜超声刀 1997 国内用腹腔镜超声刀做胆囊切除、结肠切除 1998 国内用腹腔镜超声刀做肾上腺切除、脾切除 技术成熟、经验丰富教学医院和专业医院的开展、专业医生的加入微创优点得到承认经济情况好转现状腔镜甲状腺切除 病种: 甲状腺瘤、结节性甲状腺肿、甲状腺机能亢进、甲状腺癌，甲状旁腺肿瘤。 手术：甲状腺部分切除、甲状腺次全切除、一叶全切一叶部分切除，甲状旁腺切除，甲状腺再次手术。 手术入路; 双乳晕胸前、胸前、腋下、腋乳现状腹腔镜肝脏手术 腹腔镜肝囊肿开窗术、肝包囊虫的腔镜治疗 肝切除术 病种：肝癌、血管瘤、结石、囊肿、脓肿等。 术式： 楔形切除、肝叶切除、左半肝切除、右半肝切除

3、， 完全气腹，手助。 器械：超声刀、智能双极电凝刀（Ligasur,PK刀），刮吸刀，螺旋水刀，HWD-2型腹腔镜专用微波刀，钛夹，Endo GIA,等。 效果：近期好，转开腹，并发症，远期？ 上海、广州、北京、杭州、桂林、南通、武汉、济南、福州 现状腹腔镜脾脏手术 病脾切除： 血液病、脾囊肿、脾脓肿、脾脏脉管瘤，等。 外伤脾修补术。 门脉高压巨脾切除、门奇断流手术。 手助，改良Sugiura手术现状腹腔镜胃手术 胃良性肿瘤切除术、胃良性疾病切除、穿孔缝合术。迷走神经切断术。食管旁裂孔疝修补术，减肥手术，抗反流胃底折叠术。 胃癌根治术 完全气腹、腹腔镜辅助下、手助腹腔镜胃癌根治术。 上海、重庆

4、、广州、南宁、温州 、北京等 现状腹腔镜结肠手术 是较成熟和开展较多的手术 良性病变：家族息肉病、溃疡性结肠炎、便秘、结肠息肉 结肠癌：左或右半结肠切除、横结肠切除 结直肠癌：TME。Dixon手术, 保肛低位吻合，Miles手术 。 技术比较成熟，微创优点已获承认，治疗效果亦得证实。国内尚缺循证医学资料。感谢各位的参与祝各位事业成功The Development of General Laparoscopic Surgery In China Department of Surgery, First Hospital, Peking University Guoli LiuInitial S

5、tage1991-1994 The development of LS in China was started later but the progression was fast 1991-2 laparoscopic cholecystectomy 1993 laparoscopic gastrectomy laparoscopic colectomy laparoscopic choledochotomy 1994 laparoscopic hepatectomy laparoscopic splenectomyWhy the progression was fastInterpers

6、onal factors Sensitive, positive and enthusiastic to LS, recognized the advantage of LSLaparoscopic surgery is actually minimally invasive surgeryCompany supportsLaparoscopic hepatic surgeryFenestration for liver cystLaparoscopic treatment of hydatid cystHepatectomy Kind of diseases: hepatocelllular

7、 carcinama, hepatic hemangioma, hepatolithiasis, hepatic cyst, liver abscess Operations: hepatic wedge resection, lobectomy of liver, Complete laparoscope, Hand assistant. Instruments: ultrasonic scalpel, ligasure , new type of microwave knife, PMOD, water jet dissection, Endo GIA Shanghai, Guangzho

8、u, Beijing, Hangzhou, Guilin, Nantong, Wuhan, Jinan, Fuzhou, et. Laparoscopic biliary tract surgeryLaparoscopic cholecystectomyLaparoscopic choledocholithotomyLaparoscopic resection of choledochoceleLaparoscopic choledochojejunostomy or cholecystojejunostomyTumor of biliary tract ?Laparoscopic pancr

9、eatic surgerypancreatic pseudocystogastrostomy or pseudocystojejunostomyResection of pancrea bodylaparoscopic enucleation of pancreatic islet cell tumorsPancreatoduodenectomy peri ampulla carcinoma, pancreaticojejunostomyNanning ,Shanghai,Hangzhou,Nanjing,Guangzhou,Laparoscopic splenic surgeryLaparo

10、scopic splenectomy ITP, splenic cyst, splenic abscess, splenic hemangioma, et al.Neoplasty of injured spleenPortal hypertension Hand assisted, splenectomy and pericardial devascularization, Sugiura operationLaparoscopic surgery of stomachPartial & subtotal gastrectomy for benign disease or tumorLapa

11、roscopic repair for perforation of peptic ulcerLaparoscopic vagotomySurgical treatment of paraesophageal hiatal herniaLaparoscopic antireflux surgeryLaparoscopic gastric bandingCarcinoma of stomach 、 stages，complete laparoscope, laparoscopic assisted , hand assisted.Shanghai,Chongqing,Guangzhou,Nann

12、ing,Wenzhou,Beijing, et al. Laparoscopic colonrectal surgeryAre mature and common laparoscopic operationBenign diseases: familial intestinal polyposis, ulcerative colitis, colic polyp.Carcinoma of colon left or right hemicolectomy, Rectal carcinoma TME, Dixon, miles. Good result ,minimally invasive

13、surgeryOthersLaparoscopic surgery for small bowel tumor Laparoscopic surgery for adhesiolysisEndoscopic surgery for breast cancerLaparoscopic hernia repair, oblique, direct, inciesion, Laparoscopic surgery for emergency or abdominal injury Questions and Directions Strictly control operative indicati

14、ons, avoid misdiagnosis and missed diagnosisOperating must according to the standard procedureEnhance knowledge and technique, decrease complicationsMake great efforts to yield LS good results, promote the development of laparoscopic surgery Questions and directionsMy personal opinion that LS is still in operative explore stage, is an operative technique reform or revolution .One sh