摘要
近年来, 胰腺肿瘤的诊治技术有较大进步。在诊断方面, 通过CT三维重建、PET-CT全身扫描、超声内镜及穿刺活检等, 可评估肿瘤性质、分期和生物学特性, 使治疗决策更科学合理。在治疗方面, 传统开腹胰腺手术方式推陈出新, 动脉优先、动脉鞘剥离、腹膜后淋巴脂肪板层切除等新技术层出不穷, 提高了肿瘤根治性。对于良性或低度恶性的胰腺肿瘤, 施行功能保留术式可减少远期并发症。微创入路胰腺手术飞速发展, 无论解剖性标准根治术, 还是功能保留术式, 均可在腹腔镜或机器人辅助下完成。非手术治疗方法日新月异, 部分局部进展期或晚期胰腺癌, 接受新辅助治疗后有望降期或转化后手术。诊治技术的进步促使诊治模式从分科诊治走向多学科团队协作。以精准评估为前提, 充分发挥腹腔镜和机器人手术辅助系统在诊断及治疗中的优势, 重视非手术综合治疗, 重视医患沟通并全程关怀, 是微创外科时代提高胰腺肿瘤临床疗效的关键。
In recent years,great progress has been made in the diagnosis and treatment of pancreatic tumors.In terms of diagnosis,three-dimensional CT reconstruction,PET-CT scan,endoscopic ultrasound with needle biopsy are used to evaluate the benign or malignant stage and biological characteristics of the tumor,to make treatment decisions more scientific and reasonable.In terms of treatment,new technologies,such as arterial priority arterial sheath dissection and radical resection of the retroperitoneal lipo-lymphatic layer,have continuously emerged to improve radical curability of tumors.For benign or low-grade malignant pancreatic tumors,function-preserving surgery is adopted to avoid long-term complications.Minimally invasive pancreatic surgery has advanced in leaps and bounds.Both standard radical surgery and function-preserve surgery can be performed under a laparoscope or robot.Non-surgical treatment has developed quickly with each passing day;for locally advanced or metastatic pancreatic cancer,neoadjuvant therapy is expected to be down-staged or transformed into surgery.These advances in diagnosis and treatment technology have led to multidisciplinary teamwork.Based on accurate assessment,giving full play to the advantages of laparoscopic and robotic systems in diagnosis and treatment,attaching importance to comprehensive nonsurgical treatment and doctor-patient communication with care throughout the process,these are keys to improve the clinical efficacy of pancreatic tumors in the era of minimally invasive surgery.
作者
牟一平
彭淑牖
金赟
朱启聪
Mou Yiping;Peng Shuyou;Jin Yun;Zhu Qicong(Department of Gastrointestinal and Pancreatic Surgery,Zhejiang Provincial People's Hospital,Key Laboratory of Gastroenterology of Zhejiang Province,Hangzhou 310014,China;Department of Hepato-Biliary-Pancreatic Surgery,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou310006,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2024年第7期648-653,共6页
Chinese Journal of Surgery
基金
国家卫生健康委科学研究基金-浙江省卫生健康重大科技计划(WKJ-ZJ-2201)
浙江省科技厅“领雁”重大社会公益项目(2022C03099)。
关键词
胰腺肿瘤
外科手术
腹腔镜手术
机器人手术
多学科协作
Pancreatic neoplasms
Surgical procedures,operative
Laparoscopic surgery
Robotic surgery
Multidisciplinary collaboration
