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中华普外科手术学杂志(电子版) ›› 2022, Vol. 16 ›› Issue (05) : 482 -486. doi: 10.3877/cma.j.issn.1674-3946.2022.05.003

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中国腹腔镜右半结肠癌根治术需要规范的几个问题
王贵英1,()   
  1. 1. 050011 石家庄,河北医科大学第四医院外二科;050004 石家庄,河北医科大学第二医院普外科
  • 收稿日期:2021-11-17 出版日期:2022-10-26
  • 通信作者: 王贵英

Several issues need to be standardized in laparoscopic right hemi-colectomy for right colon cancer in China

Guiying Wang1,()   

  1. 1. Department of the Second Surgery, the Fourth Hospital of Hebei Medical University, Shijiazhuang Hebei Province 050011, China; General Surgery Department of the Second Hospital of Hebei Medical University, Shijiazhuang Hebei Province 050051, China
  • Received:2021-11-17 Published:2022-10-26
  • Corresponding author: Guiying Wang
  • Supported by:
    Key Project of Hebei Precision Medicine Joint Foundation(206Z7705G); Cancer Research Program of National Cancer Center(NCC2017A23); Key project of medical science research program of Hebei Province(20160194)
引用本文:

王贵英. 中国腹腔镜右半结肠癌根治术需要规范的几个问题[J/OL]. 中华普外科手术学杂志(电子版), 2022, 16(05): 482-486.

Guiying Wang. Several issues need to be standardized in laparoscopic right hemi-colectomy for right colon cancer in China[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(05): 482-486.

历经30年的发展,中国腹腔镜右半结肠癌根治术已趋于成熟和普及。外科技术的发展和治疗理念的更新,推动了腹腔镜右半结肠癌根治术进入精准治疗阶段。由于右半结肠癌血管变异多、淋巴引流途径复杂,对于不同部位肿瘤、不同分期的右半结肠癌患者,淋巴结清扫范围、血管处理方式及手术入路的选择都存在一定的差异。本文结合近些年国内外相关研究及笔者经验,对腹腔镜右半结肠癌根治手术需要规范的几个问题进行述评。

The technique of laparoscopic radical resection of right colon cancer in China has become advanced and popularized in 30 years. The development of surgical technology and the renewal of therapy concepts have promoted the laparoscopic radical resection of right colon cancer into the stage of precision medicine.Due to the variability of blood vessels in the right colon cancer and the complicated lymphaticdrainage patterns,the range of lymph node dissection,blood vessel management and surgical approach for patients with right colon cancer differ in patients with different tumor sites and stages. Therefore,in the present paper,several issues about the standardization of laparoscopic right hemi-colectomy for right colon cancer will be discussed based on the literature and author’s experiences.

图1 右半结肠癌D3淋巴结清扫的内侧界 注:A以SMV右侧为内侧界;B以SMV左侧为内侧界;C以SMA左侧为内侧界;D以SMA中线为内侧界
图2 以ICA/ICV作为解剖标记标志
图3 中间入路:先行解剖结扎ICV/ICA,沿SMV主干由下而上进行解剖
图4 尾侧入路:先行切开右侧系膜与后腹膜的黄白交界线
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