早期肺癌迎来微创治疗3.0时代

2017-09-06 佚名 健康时报网

复旦大学附属肿瘤医院肺癌研究团队在大量临床实践的基础上准确描述并定义了肺癌“全面微创治疗3.0”的概念。近日,被学界誉为外科学圣经的权威学术期刊《外科学年鉴》在“外科学展望”一栏中在线发表了这一重要述评文章。不仅是可见创伤的最小化据论文通讯作者、肿瘤医院胸外科主任陈海泉教授介绍,在过去相当长一段时间,许多临床医生对肺癌微创治疗的理念认识仅局限于“切口小”和“少打洞”等胸腔镜技术层面,甚至一味追求、

复旦大学附属肿瘤医院肺癌研究团队在大量临床实践的基础上准确描述并定义了肺癌“全面微创治疗3.0”的概念。近日,被学界誉为外科学圣经的权威学术期刊《外科学年鉴》在“外科学展望”一栏中在线发表了这一重要述评文章。

不仅是可见创伤的最小化

据论文通讯作者、肿瘤医院胸外科主任陈海泉教授介绍,在过去相当长一段时间,许多临床医生对肺癌微创治疗的理念认识仅局限于“切口小”和“少打洞”等胸腔镜技术层面,甚至一味追求、攀比可见创伤的最小化。

陈海泉教授将这个阶段定义为肺癌微创1.0,“事实上,我们做微创的真正目标是为了让患者在创伤最小的情况下,获得和开放手术一样甚至更好的疗效和生存率,绝不是为了微创而微创。”

需对脏器做最大程度保护

过去认为大范围的转移性淋巴结清扫可降低术后复发转移风险,但预防性的对没有转移的淋巴结清扫对患者并没有好处,一味追求大范围淋巴结清扫,会对患者体内脏器造成不可见的“内伤”。

在此基础上,复旦大学附属肿瘤医院肺癌临床团队对原位未浸润贴壁的早期肺腺癌淋巴结清扫范围作了研究。研究证实,如果术中纵膈淋巴结没有转移,就不需要做淋巴结清扫。此外,肺上叶尖段<2cm且没有侵犯胸膜的肺癌,不会有淋巴结转移风险,这类患者只需要对上纵膈淋巴结清扫即可,无需进行其它范围的清扫。“相较于只追求可视创伤的最小化,这种致力于内部脏器创伤最小化的肺癌微创手术在理念上比过往有了更深入的认识。”陈海泉教授说,“这也是微创治疗由外到内全面创伤最小化的一种实践,我们也将其定义为微创2.0时代。”

是一个全面系统概念

在选择微创治疗与否、微创治疗术式过程中,病理科协同很关键。

本论文作者、胸外科医师成兴华表示,肿瘤医院在对周围型小病灶肺腺癌的微创治疗中,术中病理诊断结果直接决定微创手术的范围和策略。假如病理诊断结果为早期肺癌,外科医师无需切除肺叶就能达到治疗效果;但对原发性的恶性肿瘤,则需做标准的肺叶切除加淋巴结清扫。

在此过程中,医院病理科的术中病理诊断99.5%的准确率,也是有效、安全、准确选择微创治疗方式的最大保障。

陈海泉教授结合多年经验,并在回顾国际各大中心的相关研究后明确提出了微创3.0时代“全面微创”理念,即以胸腔镜技术为载体、由多学科共同参与,在治疗中为病人选择合适的手术、切口,保留正常肺组织、肺功能和淋巴结,在尽可能短的时间内完成手术,平衡切口、器官和系统损伤,使患者最大程度获益。”

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    2017-09-13 189****7206

    学习了受益匪浅

    0

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    2017-09-10 184****9840

    学习了受益匪浅

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    2017-09-08 vera_1203
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content=很好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo61WAV0ROeLAoicPxPKoKaogwLWLL8STv86qplbdOibN2YR4KxkJicqNectCXGR8gPJhGLc7yYLSdnpx4kaVXndTfu/0, createdBy=a6962042337, createdName=1391e9f2a7m, createdTime=Thu Sep 07 06:14:19 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241267, encodeId=7faa24126e32, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTIKlpu9buib1TxXRibfFuzYXHaLxQgfUpwzYwTMo8551BS40KVZNRDLWmAXSibjfnFm0QggOrCSWElfw/132, createdBy=95aa1617853, createdName=happy1, createdTime=Thu Sep 07 05:50:41 CST 2017, time=2017-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241257, encodeId=80e824125e6a, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Thu Sep 07 01:43:13 CST 2017, time=2017-09-07, status=1, ipAttribution=)]
    2017-09-07 榄枷檬

    谢谢分享

    0

  7. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=241257, encodeId=80e824125e6a, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4KDsF1g1gUHzGM0LHxX5B5uhEMln8y8iagso9N4XBTQVPmHrCNoT3o8bw80Ds53TpTgcPnKUIfkyw/0, createdBy=bc101976400, createdName=suibian2007bbb, createdTime=Thu Sep 07 01:43:13 CST 2017, time=2017-09-07, status=1, ipAttribution=)]
    2017-09-07 半夏微凉

    学习了谢谢分享

    0

  8. 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    2017-09-07 1391e9f2a7m

    很好的文章.学习了

    0

  9. 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    2017-09-07 happy1

    学习了

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    2017-09-07 suibian2007bbb

    学习

    0

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