腔镜技术-瑞金医院_精品文档.ppt

腔镜技术-瑞金医院_精品文档.ppt

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Minimallyinvasivesurgery微创外科郑民华郑民华上海交通大学医学院附属瑞金医院外科上海交通大学医学院附属瑞金医院外科上海交通大学医学院附属瑞金医院外科上海交通大学医学院附属瑞金医院外科上海市微创外科临床医学中心上海市微创外科临床医学中心上海市微创外科临床医学中心上海市微创外科临床医学中心21世纪外科发展方向移植外科移植外科微创外科微创外科修复外科修复外科肿瘤的分子生物学治疗肿瘤的分子生物学治疗J.PERISSATOperatingroom1896ProfessorTerrierParis1901sKeilling腹腔镜外科新腹腔镜外科新进展进展1910JacobeususedNitzeendoscopefordiagnosticlaparoscopy腹腔镜外科新腹腔镜外科新进展进展1930Kalkdualpunctureliverbiopsy腹腔镜外科新腹腔镜外科新进展进展J.PERISSATProfessorofGynaecologyKiehlPr.KurtSemmLaparoscopiccholecystectomyEmblematicoperationFirstlandmarksofthelaparoscopicrevolutionPrecursor:

EMhe1985Pioneers:

Ph.Mouret1987F.Dubois-J.Perissat1988B.McHerman1988E.J.Reddick1988腹腔镜腹腔镜外科新外科新进展进展1987Mouret世界首例腹腔镜世界首例腹腔镜胆囊切除术胆囊切除术J.PERISSATJ.PERISSAT已已经成成为金金标准的腹腔准的腹腔镜手手术腹腔镜外科新腹腔镜外科新进展进展胆囊切除术胆囊切除术脾切除术脾切除术疝修补术疝修补术抗食管反流手术抗食管反流手术肾上腺切除术肾上腺切除术LaparoscopiccholecystectomyLaparoscopicsplenectomyLaparoscopicherniarepaireLaparoscopicfundoplicationLaparoscopicadrenectomy疝修补Herniarepair腹腔镜腹腔镜NISSEN手术手术腹腔镜NISSEN手术目前已经渐趋成熟目前已经渐趋成熟即将成为金标准手术即将成为金标准手术腹腔镜外科新腹腔镜外科新进展进展结直肠切除术结直肠切除术甲状腺切除术甲状腺切除术胰尾部切除术胰尾部切除术直肠前切除术直肠前切除术左半结肠切除术左半结肠切除术右半结肠切除术右半结肠切除术横结肠切除术横结肠切除术全结肠切除术全结肠切除术乙结肠切除术乙结肠切除术milesmiles术术结肠固定术结肠固定术腹腔镜腹腔镜结直肠结直肠手术手术腹壁切口腹壁切口开腹开腹腹壁切口腹壁切口腹腔镜腹腔镜腹腔镜腹腔镜结直肠结直肠手术手术右半结肠切除术右半结肠切除术右半结肠切除术右半结肠切除术直肠切除范围直肠切除范围标本的取出与切除标本的取出与切除腹部切口腹部切口腹壁切口腹壁切口腔镜甲状腺切除术腔镜甲状腺切除术腹腔镜外科新腹腔镜外科新进展进展腔镜甲状腺切除术正在探索的手术正在探索的手术腹腔镜外科新腹腔镜外科新进展进展胃癌根治术胃癌根治术胰十二指肠头部切除术胰十二指肠头部切除术血管外科手术血管外科手术胃切除术腹腔镜胰十二指肠切除术腹腔镜胰十二指肠切除术GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspectiveOpenSurgery:

Alonglastingjourney:

from400to1990TheOdysseyoftheSurgeonshandsInsidehumanbodyHomericpoem20thCenturyTwoWorldWarsBirthandimprovementofVascularsurgeryThoracicsurgeryNeurosurgeryPlasticsurgeryResuscitation（Intensivecareunits）GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspectiveTheDilemma:

HowtomakeharmlesstheaccessofthesurgeonshandsinsidethepatientsbodyGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspectiveThespectacularAchievement:

From1950tonowadaysEndoftheDilemma:

HarmlessaccessofthesurgeonshandsinsideeverycornersofthepatientsbodyThepricetopaythedrawbacksoflargeopeningsGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspective20thCentury1990TheTurningPointUnnecessarypresenceofSurgeonshandsinsideHumanBodyJ.PERISSATLaparoscopicSurgerytheturningpointintheHistoryofSurgeryEndoscopyinitshistoricalperspective:

Endoscopy（tolookinsideancientGreek）Fromantiquityto1900endoluminalexplorationSince1901Laparoscopy（exploration）InterventionalEndolaparoscopySince1970J.PERISSATGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgeryLaparoscopicSurgerytheturningpointintheHistoryofSurgeryLAPAROSCOPICSURGERYForDIGESTIVEDISEASESLogicallearningprogressionSTEP1:

-Exploratorylaparoscopy+biopsies-Appendectomy;peritonitis-（gynaecologicemergencies）-Cholecystectomy+IOCCompletemasteryofSuturing-knottingSTEP2:

-Gastroesophagealreflux-InguinalHerniarepair-LaparoscopicapproachoftheCBD-Splenectomy;（Adrenalectomy）MostadvancedproceduresSTEP3:

-Colorectalsurgery-Oesophagus&Stomachsurgery-MajorPancreaticresections-MajorhepaticresectionsLaparoscopicSurgeryNewSpacesPleuralcavityThoracicSurgeryRetroperitonealSpacesOrthopaedicSurgeryUrologyEndocrineSurgeryVascularSurgeryInterfasciasSpacesHeadandNeckSurgeryPlasticSurgeryLaparoscopicSurgeryNewTechniques-NewInstrumentsTwoMainTrendsHumancraftsmanshipHightechnologiesAdaptationfrom-ComputersOpenproceduresto-ImagingLaparoscopicones-Teleteaching-Robots.未来未来？

J.PERISSATOprationLindberghSeptember9th2001JacquesMarescauxLaparoscopicSurgerytheturningpointintheHistoryofSurgerySurgeryinitshistoricalperspectiveThecredibleFutureIntracorporealnavigatorsPercutaneousapproachLaparoscopicsurgeonsInterventionalradiologistsIntraluminalapproachInterventionalflexibleendoscopistsLaparoscopicSurgerytheturningpointintheHistoryofSurgerySurgeryinitshistoricalperspectiveThecredibleFutureHowtodealwith?

:

Changingourminds,educationalprograms:

Changingourhealthinstitutions:

InstitutesofHighTechnologyforMISUpdatingourhospitalorganisationFutureofsurgeryOpensurgeryM.I.S.InstitutesofHighTechnologiesOncologyTransplantationTraumaAllsurgicalunitsDailypracticePermanentEducationBenigndisordersFutureOrganisationEndoUnitM.I.T.CentreInt.RadiologyLap.Surg.X.Ray.Dept.GastroenterologicaldepartmentSurgicalDept.Up-datedEvolutionM.I.T.CentreforDigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.X.Ray.Dept.TransplantUnitOpensurgeryGastroenterologicaldepartmentUp-datedEvolutionM.I.T.CentreforDigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.Tr