腔镜技术-瑞金医院_精品文档.ppt

1、Minimally invasive surgery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.PERISSATOperating room 1896 Professor Terrier Paris1901s Keilling腹腔镜外科新腹腔镜外科新进展进展1910

2、Jacobeus used Nitze endoscope for diagnostic laparoscopy腹腔镜外科新腹腔镜外科新进展进展1930 Kalk dual puncture liver biopsy腹腔镜外科新腹腔镜外科新进展进展J.PERISSATProfessor of GynaecologyKiehl Pr.Kurt SemmLaparoscopic cholecystectomyEmblematic operationFirst landmarks of the laparoscopic revolution Precursor:E Mhe 1985 Pioneers

3、:Ph.Mouret 1987 F.Dubois-J.Perissat 1988 B.Mc Herman 1988 E.J.Reddick 1988腹腔镜腹腔镜外科新外科新进展进展1987 Mouret 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Laparoscopic cholecystectomyLaparoscopic splenectomyLaparoscopi

4、c hernia repaireLaparoscopic fundoplicationLaparoscopic adrenectomy疝修补Hernia repair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

5、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Global perspective of fu

6、ture development in Endolaparoscopic Surgery Surgery in its historical perspective Open Surgery:A long lasting journey:from 400 to 1990The Odyssey of the Surgeons handsInside human bodyHomeric poem 20th CenturyTwo World WarsBirth and improvement ofVascular surgeryThoracic surgeryNeurosurgeryPlastic

7、surgeryResuscitation(Intensive care units)Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective The Dilemma:How to make harmless the access of the surgeons hands inside the patients bodyGlobal perspective of future development in Endolaparoscopic

8、Surgery Surgery in its historical perspectiveThe spectacular Achievement:From 1950 to nowadays End of the Dilemma:Harmless access of the surgeons hands inside every corners of the patients body The price to pay the drawbacks of large openingsGlobal perspective of future development in Endolaparoscop

9、ic Surgery Surgery in its historical perspective20th Century1990The Turning PointUnnecessary presence of Surgeons handsinside Human BodyJ.PERISSATLaparoscopic Surgery the turning point in the History of SurgeryEndoscopy in its historical perspective:Endoscopy(to look inside ancient Greek)From antiqu

10、ity to 1900 endoluminal explorationSince 1901 Laparoscopy(exploration)Interventional EndolaparoscopySince 1970 J.PERISSATGlobal perspective of future development in Endolaparoscopic SurgeryLaparoscopic Surgery the turning point in the History of SurgeryLAPAROSCOPIC SURGERYFor DIGESTIVE DISEASESLogic

11、al learning progression STEP 1:-Exploratory laparoscopy+biopsies-Appendectomy;peritonitis -(gynaecologic emergencies)-Cholecystectomy+IOCComplete mastery of Suturing-knottingSTEP 2:-Gastroesophageal reflux -Inguinal Hernia repair -Laparoscopic approach of the CBD -Splenectomy;(Adrenalectomy)Most adv

12、anced proceduresSTEP 3:-Colorectal surgery -Oesophagus&Stomach surgery -Major Pancreatic resections -Major hepatic resections Laparoscopic SurgeryNew Spaces Pleural cavity Thoracic Surgery Retroperitoneal Spaces Orthopaedic Surgery Urology Endocrine Surgery Vascular Surgery Interfascias Spaces Head

13、and Neck Surgery Plastic Surgery Laparoscopic SurgeryNew Techniques-New InstrumentsTwo Main TrendsHuman craftsmanship High technologiesAdaptation from -ComputersOpen procedures to -ImagingLaparoscopic ones-Teleteaching-Robots.未来未来？J.PERISSATOpration Lindbergh September 9th 2001Jacques MarescauxLapar

14、oscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective The credible FutureIntracorporeal navigators Percutaneous approach Laparoscopic surgeons Interventional radiologists Intraluminal approach Interventional flexible endoscopistsLaparoscopic Surgery the tu

15、rning point in the History of Surgery Surgery in its historical perspectiveThe credible FutureHow to deal with?:Changing our minds,educational programs:Changing our health institutions:Institutes of High Technology for MIS Updating our hospital organisation Future of surgeryOpen surgery M.I.S.Instit

16、utes of High TechnologiesOncologyTransplantationTraumaAll surgical unitsDaily practicePermanent Education Benign disordersFuture OrganisationEndo UnitM.I.T.CentreInt.RadiologyLap.Surg.X.Ray.Dept.GastroenterologicaldepartmentSurgicalDept.Up-dated EvolutionM.I.T.Centre for DigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.X.Ray.Dept.TransplantUnitOpensurgeryGastroenterologicaldepartmentUp-dated EvolutionM.I.T.Centre for DigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.Tr