发育医学电子杂志  2017, Vol. 5 Issue (3): 190-192 |
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结构畸形
综述
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| 小儿外科精准微创技术的发展现状 |
| 黄柳明 |
| 陆军总医院附属八一儿童医院 儿童基础外科，北京 100700 |
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| Development status of precision minimally invasive technique of pediatric surgery |
| HUANG Liu-ming |
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摘要 进入21世纪，借助科技进步，小儿外科呈现两大发展趋势。一方面，外科手术向微创化发展，即传统手术采用微创技术来完成，使手术创伤小，切口不明显甚至无瘢痕；另一方面，外科手术向高难度发展，突破过去人们所认为的禁区，采用高难度手术治疗“不可切除的病变”或者“不可治疗的畸形”。这两大发展趋势促进了小儿外科精准微创技术的建立和成熟。“精准”包括以下要素：①彻底根除病变，彻底矫正畸形，复原机体正常解剖，无损组织功能；②手术视野全面、立体，可在微观层次辨别病变与正常组织的界限；③要求稳定、准确、精细和轻柔，少异物，无不必要的操作，避免人为损伤正常组织。“微创”包括以下要素：①皮肤切口小，正常组织分离少，器官移动少，出血少，炎症反应轻；②身心破坏小，手术打击小，手术时间短；③术后身心后遗症降到最低。精准与微创是互相依托、互相关联的两个方面，精准是微创的目的，微创是精准的手段。
众所周知，外科是创伤性治疗疾病的方式，以祛除病变为目的，付出机体损伤为代价。20世纪80年代以前，受医疗条件和技术的限制，曾一度流行大切口，承受较大的创伤，以求充分暴露，彻底矫治病变。而“精准微创”外科技术的理念提倡以最小的创伤和最少的痛苦，来获得最佳的治疗效果，是传统手术发展成熟和科技发展创新的必然趋势。小儿不是成人的等比例缩影，身体器官脆弱，尚待生长和成熟，将精准微创手术技术应用于小儿外科疾病的治疗更为必要，也是发展使然。“精准微创”外科技术并非是一门专业，而是小儿外科工作中必须遵循的基本理念，与无菌观念一样，应贯穿于外科实践中，是对现代小儿外科医生的时代要求。
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收稿日期: 2016-09-12
出版日期: 2017-07-30
发布日期: 2018-01-16
期的出版日期: 2017-07-30
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| 基金资助: 公益性行业科研专项（201402007） |
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通讯作者:
黄柳明
E-mail: surhlm@126.com
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