摘要
随着＂精准医学＂概念的提出和推广，对于疾病发生、进展及转归有了更加精确细致的认识，使得外科治疗理念也越来越精准化和微创化。以腹腔镜手术为主的微创治疗已成为胃癌治疗的重要组成部分。准确掌握手术指征是胃癌微创治疗的前提，KLASS-01及CLASS-01等多项随机对照临床研究结果证实，对于早期胃癌、主要是临床诊断为Ⅰ期的胃癌，腹腔镜远端胃癌可以作为常规治疗手段，在严格把握手术指征下，也可选择内镜下治疗；对于进展期胃癌，规范标准的腹腔镜胃癌根治术的安全性与开放手术一致。专业化治疗模式是胃癌微创治疗实施的保障，包括准确判断肿瘤位置、切除范围及淋巴结清扫范围，以最小的手术创伤治愈胃癌，并防控术后并发症的发生。具有系统规范诊疗模式的胃癌专业诊疗团队结合规范的手术操作，具有更好的微创治疗实践能力，是推动微创外科发展的重要力量；而如何利用专业化的胃癌诊疗团队去培训和带动基层医疗中心、形成专业化的胃癌诊疗模式、进而改善患者预后，是目前亟需解决的问题。随着器械和设备的更新，胃癌微创治疗的发展趋向更专业、更精确、更安全、更微创。在精准医学背景下，深入探索胃癌发病转归机制，规范专业化胃癌微创治疗体系及制度，优化加强团队内培训，才能满足新时代精准医学背景下胃癌治疗的安全、微创、有效的需求。
With the introduction and promotion of＂precision medicine＂conception, the history of disease occurrence, progression and prognosis has been deeply investigated with more accuracy, and the surgical treatment concept has become more precise and minimally invasive. With the rapid development of minimally invasive technique, laparoscopic gastrectomy has become an important part for treatment of gastric cancer. A number of randomized controlled clinical trials, such as KLASS-01 and CLASS-01, have demonstrated that laparoscopic gastrectomy is safe and feasible for treatment of early and locally advanced gastric cancer, respectively. Endoscopic treatment would also be considered with strict indications. The surgical safety is identical between standard laparoscopy surgery and open surgery for local advanced gastric cancer. Radical cure, organ function preservation and reduced surgical trauma are the basic rules for minimally invasive treatment for gastric cancer. Specialized treatment mode, which consists of precise evaluation of tumor location, gastrectomy and lymph node resection, reduced surgical trauma and control of postsurgical complications, is the premise for implementation of minimally invasive surgery. Accurate preoperative staging, strict indication of operation, accurate quality control and postoperative management are important warrants for the effect of minimally invasive treatment in patients with gastric cancer. With standard diagnosis and treatment procedures, the specialized treatment mode for gastric cancer combined with standard surgical resection is an important force to promote the development of minimally invasive surgery. And what should we do to train and promote gastric cancer treatment in primary medical care centers is an urgent problem. With the development of equipment, minimally invasive treatment will be more professional, more precise, safer and less invasive. In the era of precision medicine, with deeper exploring the pathogenesis of gastric cancer, promoting the development of specialized treatment mode and strengthened surgical team training could meet the demand for minimally invasive treatment of gastric cancer. Therefore, specialized minimally invasive treatment is the trend of minimally invasive treatment for gastric cancer in the new era.
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2017年第8期847-851,共5页
Chinese Journal of Gastrointestinal Surgery
关键词
胃肿瘤
微创治疗
专业化
腹腔镜
安全性
Stomach neoplasms
Minimally Invasive Treatment
Specialization
Laparoscopy
Safety
