做开腹手术还是做微创手术?

肠癌手术做开腹手术还是做微创手术的选择依据

第一节 手术方式主要看医生熟练哪种方式,医生自己做熟练的手术方式就是好的方式

用腹腔镜做微创肠癌手术特别是做低位直肠癌手术,究竟是用开腹手术好呢?还是做微创手术好呢?手术方式主要看医生熟练哪种方式,医生自己做熟练的手术方式就是好的方式,不论是开腹受还是微创手术。我做的手术就是微创手术,我的手术医生就是微创中心主任,亚洲还没有微创手术的时候,他就到处去很多国家做微创示范手术了,这种医生你让他做开腹手术显然不合适,他肯定笨手笨脚手忙脚乱的;而你让他做微创手术他就得心应手,他告诉我微创手术有可以放大的屏幕,可以随时放大他想看得更清楚的地方,不放大时与目视无异,微创镜头可以放大,理论上看得更清楚,可以找到更多的淋巴结。

其实,能不能把该切的淋巴结切干净,是医生对少切除淋巴结危害性的认知程度使然,有些医生认为不肿大的淋巴结就不会转移,其实不然,刚被侵犯来不及肿大的淋巴结照样会转移;另外一个问题是医生对淋巴结位置的熟悉程度,经验丰富的医生知道各站、各组淋巴结的准确位置,知道那段肠子的淋巴结第一站和第二站都有什么淋巴结,他可以在麻醉的时间里,熟练的切除相关的淋巴结,开腹可以多取淋巴结的说辞不值一驳,而开腹手术创口大、出血多,对患者的伤害大、恢复慢却是患者和家属可以很直观的感受到的事情,像做直肠癌手术做不做临时造口保护一样,医生熟练那种手术方式,你选他了就用他熟悉有把握的手术方式给患者做手术。

第二节 微创手术面世近三十年了,成熟的微创手术相对优于开腹手术

做微创手术有伤口小容易愈合的好处,微创手术传到亚洲都有30年左右了,还在做开腹手术的医生,起码是不爱学习,不太接受新技术的医生,或许他没有学习实践新技术的机会。所以,我认为假如两个医生的专业学历和手术经验相同的前提下,应该选熟悉做微创手术的医生做手术。千万别强烈要求、建议做开腹手术的医生做微创手术,也不要要求建议习惯做微创手术的医生勉为其难的做开腹手术。微创手术伤口小好缝合也好愈合,几个做为插入医疗器械进腹腔手术的创口,术后就贴了一片防水胶布,几天后撕掉防水胶布就愈合了,我出院回家就可以在花洒头底下洗澡了,我术后的第五天就背着电脑走路回家了,要是做开腹手术我肯定没有那么快恢复,我最大的微创刀口(拖切除的肠子出腹腔的左边下腹位置)现在都几乎找不着疤痕了。

术有专攻,每个医生实习时跟的教授的手术方式不一样,形成的手术习惯、手术的把握也就不一样,我们对医生的专业知识和经验的来源要有一个清晰的认识和相对准确的判断!比如,经常做多学科会诊的肿瘤外科医生的肿瘤内科知识就不亚于很多的肿瘤内科医生;经验丰富的肿瘤外科医生做出放化疗强度和次数建议的参考价值就非常高;而肿瘤内科医生却不太懂肿瘤外科的专业问题。

第三节  我们对医生的专业知识和经验来源,和跨学科能力要有一个清晰的认识和相对准确的判断!

我的手术医生告诉我不需要放疗的依据清楚明确,让人有信心听他的,他还教我报个沙田的假地址去威尔士亲王医院化疗,规避归属地化疗规定,避免去九龙见到3a期就一定要做放疗的伊丽莎白医院做化疗,告诉我威尔士亲王医院看到距离肛门7公分,一个淋巴结转移,处于在可放疗可不放疗之间,说这个医院的肿瘤内科医生分析比较仔细,这种病情,看到是专家医生做的手术,看到术后病理切除37个淋巴结,肠环周一圈的脂肪被切掉10mm,(他说一般医生只切1-2mm)他说这个医院的肿瘤内科医生综合判断之后,就会同意你不放疗的要求,他说他手术做得很干净,很多地方都切到骨边上了,他很有把握不需要放疗,只做8次化疗就足够了,说切干净之后的无谓放疗反而伤害到肛门的功能,当时,我一知半解的问他要是没有放疗,以后会不会转移到其它的淋巴结呢?他问我,三站淋巴结他都切除干净了,还往哪里转移呢?他非常专业和非常坚定的态度给我不做放疗的信心很重要!

可见有些外科医生艺高人胆大,外科手术知识就滚瓜烂熟,而肿瘤内科的那些知识,这些经常参加多学科联合诊疗的专家医生其实都了如指掌,何况,手术是他做的,他对术后周边淋巴结或其它高风险的组织是否切除干净了他心中有数!其实,2-3期患者常规使用的放化疗疗程,出名的肿瘤外科医生都耳熟能详,术前新辅助治疗的兴起,肿瘤内科和肿瘤外科疗程交叉治疗,也倒逼这些经常参加多学科联合诊疗的外科专家医生学习肿瘤内科知识,所以,我认为术后主刀医生的后续指导意见相当重要,包括他介绍的肿瘤内科医生和放化疗大概强度和次数。

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