1987, Lyon, France, Philipe Mouret with laparoscopic cholecystectomy in the first successful, minimally invasive surgery came into being. Past two decades, minimally invasive surgery means not only getting an unexpected rich and full, the breadth of its scope but also people anticipated. In tumor treatment, minimally invasive surgery is not only used for each stage of cancer treatment, and can complete most of the traditional surgery can accomplish. Although today's minimally invasive surgery can not completely replace traditional surgery, but has in many ways demonstrated its superiority and irreplaceable.
In the process of long-term development of modern surgery, the surgical sector has been the pursuit of a goal is how to treat the disease, based on the procedure itself to minimize harm to patients. To achieve this goal, requires the minimally invasive treatment of tumors in the following two aspects should be as follows: (1) as for therapeutic purposes (radical or palliative), (2) to minimize patient pain (including iatrogenic and disease are the cause of the pain), to maximize the protection of peritumoral normal tissues and organs of the functional integrity and quality of life.
Modern minimally invasive treatment of cancer is broadly divided into the following three areas:
(1) Laparoscopic Surgery
Removal of the tumor using endoscopic techniques have not news, application laparoscopic colon resection, rectal cancer resection, gastric resection, ovarian and uterine tumor resection, and even hepatectomy, pancreaticoduodenectomy, etc. have been There are many reports. Surgical trauma is indeed significantly reduced compared with traditional methods. However, its limitations can not be ignored: the lymph node dissection, tumor-free technology, the integrity of such specimens, have varying degrees of defects. Meanwhile, carbon dioxide laparoscopic surgery pneumoperitoneum and hypercapnia, the pressure of artificial pneumoperitoneum in the respiratory and circulatory effects of pneumoperitoneum on renal hemodynamics, abdominal compartment syndrome and other hazards on the body to be further clarified.
(2) the reform of traditional minimally invasive surgery
In the past to reduce the cancer recurrence rate, expanding the scope of surgical resection, but the last 20 years, people have to expand the trauma of surgery and effect into question. Line of early breast cancer breast-conserving surgery, the treatment effect can be comparable with radical surgery, this has been recognized, its cosmetic effect is radical surgery can not match. Renowned expert Professor Tang Zhaoyou hepatobiliary surgery also suggested the efficacy of local resection liver hepatectomy is effective than 5-year survival rate of up to 64.4%. Liver cirrhosis patients with hepatectomy, some patients died during surgery after the success of liver failure, and the partial removal of the operative mortality rate was significantly lower than the survival time is prolonged. With the longevity of the crowd, accompanied by senior cancer and cardiovascular diseases and other important organs gradually increasing the proportion of patients, many patients can not tolerate traditional surgery, we also need to reform the traditional minimally invasive surgery.
(3) Other:
Interventional therapy, radiofrequency ablation, microwave therapy, focused ultrasound therapy, photodynamic therapy, argon-helium cryoablation, radiation seed implantation and so on. Unlike the former two by the surgeon to implement the method of direct excision of the tumor, a wide variety of such methods, principles, different, but the results are in situ inactivation of the tumor, and by the internal medicine, radiology, ultrasound and other medical departments to implement.
In general, minimally invasive treatment of cancer has the following advantages: (1) trauma, only a small incision in the body surface or no open incision, rapid recovery. (2) partial curative effect. (3) can play a radical role in early cancer, advanced tumors can be achieved by palliative care and other purposes. (4) positioning accuracy, selectivity, to maximize protection of normal tissues and organs function. Because of these many advantages, minimally invasive treatment has become indispensable in comprehensive cancer treatment an important part.
Minimally invasive therapy is a local treatment, in the control and elimination of local lesion, the treatment with chemotherapy and biological means have an absolute advantage in comparison, but it is not a panacea. In practice we can not one-sided pursuit of minimally invasive. Only a matter of fact should be strictly controlled disease, a reasonable selection of appropriate means, and in combination with other effective way to fully reflect the advantages of minimally invasive treatment to improve the therapeutic effect.
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