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中华普外科手术学杂志(电子版) ›› 2018, Vol. 12 ›› Issue (03) : 181 -184. doi: 10.3877/cma.j.issn.1674-3946.2018.03.001

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腹腔镜右半结肠癌根治术的难点与争议
郑民华1,(), 马君俊1   
  1. 1. 上海交通大学医学院附属瑞金医院胃肠外科;上海市微创外科临床医学中心
  • 收稿日期:2018-02-26 出版日期:2018-06-26
  • 通信作者: 郑民华

The difficulties and controversies of laparoscopic right hemicolectomy

Minhua Zheng1,(), Junjun Ma1   

  1. 1. Department of Gastrointestinal Surgery, Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine; Shanghai Minimal Invasive Surgery Center, Shanghai 200025, China
  • Received:2018-02-26 Published:2018-06-26
  • Corresponding author: Minhua Zheng
  • About author:
    Corresponding author: Zheng Minhua, Email:
  • Supported by:
    3-year promotion project of clinical skill and innovation of municipal hospital(No. 16CR1011A); Shanghai science and Technology Commission Star Program project(No.96QB14019); National high technology research and development plan project(No. 2012AA021103)
引用本文:

郑民华, 马君俊. 腹腔镜右半结肠癌根治术的难点与争议[J]. 中华普外科手术学杂志(电子版), 2018, 12(03): 181-184.

Minhua Zheng, Junjun Ma. The difficulties and controversies of laparoscopic right hemicolectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2018, 12(03): 181-184.

腹腔镜右半结肠癌根治术的手术技术已经非常成熟。但在淋巴清扫和手术入路方面,仍存在一些细节问题,成为当前争论的焦点。如淋巴清扫的内侧界,结肠肝曲癌常规清扫No.6淋巴结,手术入路除了经典的中间入路之外,头侧入路和尾侧入路是否更有优势,以及手术中的对Henle’s干解剖变异的认识等。

Laparoscopic right hemicolectomy for right colon cancer is now technically mature. However, it remained some controversies in terms of lymph node dissection and surgical approach, including the definition of the medial border of D3 lymph node dissection, the necessity of No.6 LN dissection for right colon cancer especially when tumor located in hepatic flexure, the anatomical variation of Henle’s trunk, and the selection of different surgical approach for right colon cancer, such as medial approach, caudal approach and cranial approach, etc.

[1]
Zurleni T, Cassiano A, Gjoni E, et al. Surgical and oncological outcomes after complete mesocolic excision in right-sided colon cancer compared with conventional surgery: a retrospective, single-institution study[J]. International Journal of Colorectal Disease, 2018,33(1):1-8.
[2]
池畔,官国先.不断提高腹腔镜右半结肠癌根治术规范化水平[J/CD].中华普外科手术学杂志(电子版),2017,11(2):91-94.
[3]
Spasojevic M, Stimec BV, Dyrbekk AP,et al. Lymph node distribution in the d3 area of the right mesocolon: implications for an anatomically correct cancer resection. A postmortem study[J]. Diseases of the Colon & Rectum, 2013, 56(12):1381-1387.
[4]
Søndenaa K, Quirke P, Hohenberger W, et al. The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : proceedings of a consensus conference[J]. International Journal of Colorectal Disease, 2014, 29(4):419-428.
[5]
Lee SD, Lim SB. D3 lymphadenectomy using a medial to lateral approach for curable right-sided colon cancer[J]. International Journal of Colorectal Disease, 2009, 24(3):295-300.
[6]
苏向前,张成海.腹腔镜右半结肠癌CME根治术与策略[J/CD].中华普外科手术学杂志(电子版),2017,11(2):95-98.
[7]
Toyota S, Ohta H, Anazawa S. Rationale for extent of lymph node dissection for right colon cancer[J]. Diseases of the Colon & Rectum, 1995, 38(7):705-711.
[8]
Hohenberger W, Weber K, Matzel K, et al. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome[J]. Colorectal Disease the Official Journal of the Association of Coloproctology of Great Britain & Ireland, 2009, 11(4):354-364.
[9]
Kessler H, Hohenberger W. Extended Lymphadenectomy in Colon Cancer is Crucial[J]. World Journal of Surgery, 2013, 37(8):1789-1798.
[10]
Shinohara H, Kurahashi Y, Kanaya S, et al. Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery[J]. Gastric Cancer, 2013, 16(4):615-620.
[11]
胡祥. 日本第15版《胃癌处理规约》及第5版《胃癌治疗指南》更新内容解读[J]. 中国实用外科杂志,2017, 37(4):394-398.
[12]
Bertelsen CA, Bols B, Ingeholm P, et al. Lymph node metastases in the gastrocolic ligament in patients with colon cancer[J]. Diseases of the Colon & Rectum, 2014, 57(7):839-845.
[13]
Uematsu D, Akiyama G, Sugihara T, et al. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure[J]. Asian Journal of Endoscopic Surgery, 2017, 10(1):23-27.
[14]
Feng B, Sun J, Ling TL,et al.Laparoscopic complete mesocolicexcision (CME) withmedial access for right-hemi colon cancer:Feasibility and technical strategies[J]. Surg Endosc,2012, 26(12):3669-3675.
[15]
Alsabilah J, Kim WR, Kim NK. Vascular Structures of the Right Colon: Incidence and Variations with Their Clinical Implications[J]. Scand J Surg,2017, 106(2):107-115.
[16]
Miyazawa M, Kawai M, Hirono S, et al. Preoperative evaluation of the confluent drainage veins to the gastrocolic trunk of Henle: understanding the surgical vascular anatomy during pancreaticoduodenectomy[J]. J Hepato-Bil-Pan Sci, 2015, 22(5):386-391.
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