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中华普外科手术学杂志(电子版) ›› 2019, Vol. 13 ›› Issue (05) : 440 -443. doi: 10.3877/cma.j.issn.1674-3946.2019.05.003

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腹腔镜右半结肠癌扩大切除原则与评价
肖毅1,†(), 陆君阳1   
  1. 1. 100730　中国医学科学院　北京协和医学院　北京协和医院基本外科
  • 收稿日期:2019-06-01 出版日期:2019-10-26
  • 通信作者: 肖毅

Principle and evaluation of extended laparoscopic right colectomy for colon cancer

Yi Xiao1,†(), Junyang Lu1   

  1. 1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2019-06-01 Published:2019-10-26
  • Corresponding author: Yi Xiao
  • About author:
    Corresponding author: Xiao Yi, Email:
  • Supported by:
    Capital Clinical Characteristic Applied Research and Achievement Promotion Project(NO.Z161100000516014)
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肖毅, 陆君阳. 腹腔镜右半结肠癌扩大切除原则与评价[J]. 中华普外科手术学杂志(电子版), 2019, 13(05): 440-443.

Yi Xiao, Junyang Lu. Principle and evaluation of extended laparoscopic right colectomy for colon cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2019, 13(05): 440-443.

完整结肠系膜切除原则(CME)在结肠癌手术中的应用已有十年，该原则强调了解剖平面下的结肠完整系膜切除，中央组淋巴结的清扫，饲养血管的中央部位结扎和离断。但在随后的临床应用和推广中，人们发现该原则在诸多方面并未有准确定义，比如右半结肠癌的手术中中央组淋巴结清扫的界限、肠管切除长度等。以该原则实施手术的质量控制标准等问题也是在不断的实践过程中得以明确。本文拟对腹腔镜右半结肠癌扩大切除的定义、CME手术的原则进行梳理，论述腹腔镜右半结肠癌扩大切除手术的评价标准。

关键词: 结肠肿瘤, 结肠系膜, 腹腔镜检查, 完整结肠系膜切除

The principle of complete mesenteric excision (CME) has been applied in colon cancer surgery for ten years. The concept of CME emphasized embryological anatomical complete resection of mesocolon, dissection of the central lymph nodes and high ligation of feeding vessels However, in the subsequent clinical application and promotion, it was found that the principle has not been accurately defined in many aspects, such as the boundary of the central lymph node dissection and the length of the bowel resection in the right colectomy for colon cancer. The quality control standards for CME procedure has also been clarified in the process of continuous practice. This article reviews the definition of extended laparoscopic resection of right colon cancer and the principles of CME operation, and discusses the evaluation criteria of extended laparoscopic resection of right colon cancer.

Key words: Colonic neoplasms, Mesocolon, Laparoscopy, Complete mesocolic excision
图1 按CME原则对盲肠癌实施中央组淋巴结清扫后的术野情况
图2 右半结肠癌CME手术强调的沿升结肠系膜后叶与后腹膜之间锐性分离(北京协和医院孙蒙清医生绘图) [Ascending colon，升结肠；Anterior aspect of mesocolon，结肠系膜前叶；Superior mesenteric vessels，肠系膜上血管；Posterior aspect of mesocolon，结肠系膜后叶；Toldt’s fascia，Toldt’s筋膜；Right gonadal vessels，右侧生殖血管；Right ureter，右侧输尿管；Retroperitoneum，后腹膜。]
图3 右半结肠癌淋巴结清扫范围[A. D2根治术，在SMV右侧离断饲养血管；B. D3根治术，裸化SMV，于其左侧离断饲养血管]
图4 右半结肠CME手术标本[A.结肠系膜正面；B．结肠系膜背面]
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