微创技术对胃癌个体化手术的影响
摘 要 胃癌是危害人类健康的严重疾病之一，个体化手术成为当代胃癌外科治疗的发展要求，而科学技术的飞速发展推动了微创技术在胃肠外科中的应用。本文探讨微创技术对胃癌个体化手术的影响，包括微创外科的特征、个体化治疗对胃癌手术的要求和胃癌微创手术的变化趋势，重点论述基于多学科团队（multidisciplinary team）模式的术前分期在胃癌个体化手术选择中的地位，胃癌术式的多样性及循证医学下的个体化术式的选择，基于动脉导航（arterial navigation）的现有胃癌淋巴清扫的个体化要求，术中再分期、方案再制定及落实等术者经验与决策对胃癌个体化手术的重要影响。
关键词 胃癌 微创技术 个体化治疗 胃肠外科
中图分类号：R656; R730.56; R735.2 文献标识码：C 文章编号：1006-1533（2014）23-0008-09
Influence of minimally invasive techniques
on individualized surgery for gastric cancer*
CAI Qingping**， ZHANG Xin
（Department of Gastrointestinal Surgery， Changzheng Hospital， Second Military Medical University， Shanghai 200003， China）
Abstract Gastric cancer is a major global health problem. Individualized surgery has become a requirement for the development of surgical treatment for gastric cancer. The rapid development of science and technology promotes the application of minimally invasive techniques in gastrointestinal surgery. In this review， we aim to explore the influence of minimally invasive techniques on individualized surgery for gastric cancer， including the characteristics of the era of minimally invasive surgery， request of individualized treatment on surgery of gastric cancer and the development trend of minimally invasive surgery for gastric cancer. Particularly， we would discuss the guiding importance of preoperative staging based on multidisciplinary treatment for the option of individualized surgery for gastric cancer， the diversity of surgical method in the era of minimally invasive surgery and the option of surgical methods based on evidenced-based medicine， individual requirements for current lymph node dissection strategy based on arterial navigation， and the important role of the operator’s experience in individualized surgery， including intraoperative re-staging， and the reenacting and implement of surgical methods.
Key words gastric cancer; minimally invasive techniques; individualized treatment; gastrointestinal surgery
胃癌是消化系统的常见恶性肿瘤类型，同时也是一种恶性程度极高的肿瘤，其患者的总体5年生存率只有20% ～ 30%[1]。在西方国家，胃癌的发病率有逐年下降的趋势，但在肿瘤相关死亡原因的排行榜上，胃癌仍然高居第4位[2]。在我国，胃癌的发病率和死亡率均居所有恶性肿瘤的第2位[3]。根治性的外科手术被认为是唯一可能治愈胃癌的治疗手段。在过去的半个多世纪中，数代胃肠外科医师苦心钻研，在循证医学研究的导引下，最终将D2根治术确立为进展期胃癌的标准术式[4]。毫无疑问，这一共识在外科医师与胃癌的斗争史上具有里程碑性的意义。随着标准的胃癌D2根治术的规范性开展以及各种新型放、化疗手段的应用，胃癌患者的预后有了显著改善。