切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (01) : 5 -8. doi: 10.3877/cma.j.issn.1674-3946.2024.01.002

专家论坛

腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略
杜晓辉(), 崔建新   
  1. 100853 北京,解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2023-10-07 出版日期:2024-02-26
  • 通信作者: 杜晓辉

The strategy of D3 lymph node dissection for laparoscopic radical right hemicolectomy on right colon cancer

Xiaohui Du(), Jianxin Cui   

  1. Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2023-10-07 Published:2024-02-26
  • Corresponding author: Xiaohui Du
  • Supported by:
    National Natural Science Foundation(81871317)
引用本文:

杜晓辉, 崔建新. 腹腔镜右半结肠癌D3根治术淋巴结清扫范围与策略[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 5-8.

Xiaohui Du, Jianxin Cui. The strategy of D3 lymph node dissection for laparoscopic radical right hemicolectomy on right colon cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 5-8.

完整结肠系膜切除联合D2或D3淋巴结清扫的理念和技术逐步成熟,腹腔镜右半结肠癌D3淋巴结清扫范围包括肠旁淋巴结、中间淋巴结和中央淋巴结,实践中具体的清扫范围尚未完全统一,主要争议在中央淋巴结清扫内侧界及幽门下区淋巴结清扫。笔者团队建议应个体化确定中央淋巴结清扫内侧界,T2-3期肿瘤患者建议以肠系膜上静脉(SMV)左侧为内侧界,T4期肿瘤或SMV表面有肿大淋巴结患者则以肠系膜上动脉(SMA)中线为内侧界进行淋巴结清扫。此外,术前准确分期定位、合理的手术入路、术中淋巴结示踪技术、肠系膜上神经丛保护技术可以协助完成更加精准、安全的D3淋巴结清扫。

The concept and technique of complete mesocolectomy combined with D2 or D3 lymph node dissection is widely accepted. Laparoscopic D3 lymph node dissection of laparoscopic right hemicolectomy included parenteral lymph nodes, intermediate lymph nodes and central lymph nodes. In practice, the specific extent of dissection has not been clearly defined, which is mainly reflected in the medial border of central lymph node dissection and the lymph node dissection in the subpyloric region. We suggest that the medial border of central lymph node dissection should be determined individually. Patients with clinical stage T2-3 could use the left side of Superior Mesenteric Vein(SMV) as the medial border, and patients with clinical stage T4 or SMV with enlarged lymph nodes on the surface should use the Superior Mesenteric Artery(SMA) midline as the inner border for lymph node dissection. In addition, accurate staging before surgery, reasonable surgical approach, intraoperative lymph node tracing technique, and superior mesenteric plexus protection technique can assist in more accurate and safe D3 lymph node dissection.

图1 头侧入路清扫显露SMV及胃结干 图2 头侧尾侧入路汇合显露胃结干及分支 图3 以SMV左侧为界的淋巴结清扫
[1]
池畔,黄胜辉. 中国腹腔镜右半结肠癌手术20年回顾与展望[J/CD]. 中华普外科手术学杂志(电子版), 2021, 15(05): 473–476.
[2]
杜峻峰,李世拥. 中国腹腔镜右半结肠癌手术20年历程与发展[J/CD]. 中华普外科手术学杂志(电子版), 2021, 15(05): 486–490.
[3]
Gillot CHureau JAaron C,et al. THE SUPERIOR MESENTERIC VEIN,AN ANATOMIC AND SURGICAL STUDY OF EIGHTY-ONE SUBJECTS[J]. J Int Coll Surg, 1964, 41: 339–369.
[4]
Hashiguchi YMuro KSaito Y,et al. Japanese Society for Cancer of the Colon and Rectum(JSCCR)guidelines 2019 for the treatment of colorectal cancer[J]. Int J Clin Oncol, 2020, 25(1): 1–42.
[5]
中华医学会肿瘤学分会,国家卫生健康委员会医政司. 中国结直肠癌诊疗规范(2023版)[J]. 协和医学杂志, 2023, 14(04): 706–733.
[6]
Schmoll HJVan Cutsem EStein A,et al. ESMO Consensus Guidelines for management of patients with colon and rectal cancer. a personalized approach to clinical decision making[J]. Ann Oncol, 2012, 23(10): 2479–2516.
[7]
Spasojevic MStimec BVDyrbekk 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]. Dis Colon Rectum, 2013, 56(12): 1381–1387.
[8]
Nesgaard JMStimec BVSoulie P,et al. Defining minimal clearances for adequate lymphatic resection relevant to right colectomy for cancer: a post-mortem study[J]. Surg Endosc, 2018, 32(9): 3806–3812.
[9]
Zhou LDiao DYe K,et al. The Medial Border of Laparoscopic D3 Lymphadenectomy for Right Colon Cancer: Results from an Exploratory Pilot Study[J]. Dis Colon Rectum, 2021, 64(10): 1286–1296.
[10]
刁德昌,卢新泉,何耀彬,等. 动脉优先入路法腹腔镜右半结肠癌根治术的可行性及应用价值[J]. 中华胃肠外科杂志, 2017, 20(01): 90–93.
[11]
Ricciardi RMadoff RDRothenberger DA,et al. Population-based analyses of lymph node metastases in colorectal cancer[J]. Clin Gastroenterol Hepatol, 2006, 4(12): 1522–1527.
[12]
Kotake KMizuguchi TMoritani K,et al. Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer[J]. Int J Colorectal Dis, 2014, 29(7): 847–852.
[13]
Uematsu DAkiyama GSugihara T,et al. Laparoscopic radical lymph node dissection for advanced colon cancer close to the hepatic flexure[J]. Asian J Endosc Surg, 2017, 10(1): 23–27.
[14]
Toyota SOhta HAnazawa S. Rationale for extent of lymph node dissection for right colon cancer[J]. Dis Colon Rectum, 1995, 38(7): 705–711.
[15]
Bertelsen CABols BIngeholm P,et al. Lymph node metastases in the gastrocolic ligament in patients with colon cancer[J]. Dis Colon Rectum, 2014, 57(7): 839–845.
[16]
杜晓辉,张红亮. 腹腔镜右半结肠切除术外侧入路和内侧入路合理选择:争议与共识[J]. 中国实用外科杂志, 2020, 40(03): 278–281.
[17]
Park SYPark JSKim HJ,et al. Indocyanine Green Fluorescence Imaging-Guided Laparoscopic Surgery Could Achieve Radical D3 Dissection in Patients With Advanced Right-Sided Colon Cancer[J]. Dis Colon Rectum, 2020, 63(4): 441–449.
[18]
廖伟林,刁德昌,汪佳豪,等. 腹腔镜右半结肠癌根治术采用淋巴示踪技术引导肠系膜上动脉旁淋巴结清扫的临床意义[J]. 结直肠肛门外科, 2022, 28(05): 449–455.
[19]
Watanabe JOta MSuwa Y,et al. Real-Time Indocyanine Green Fluorescence Imaging–Guided Complete Mesocolic Excision in Laparoscopic Flexural Colon Cancer Surgery[J]. Dis Colon Rectum, 2016, 59(7): 701–705.
[20]
Thorsen YStimec BAndersen SN,et al. Bowel function and quality of life after superior mesenteric nerve plexus transection in right colectomy with D3 extended mesenterectomy[J]. Multicenter Study, 2016, 20(7): 445–453.
[21]
熊智魁,陈君臣,张雄杰,等. 腹腔镜下保留自主神经右半结肠癌D_3根治术的可行性及应用价值分析[J]. 微创医学, 2019, 14(05): 568–570.
[22]
赵鑫,郭释琦,张宏. 右半结肠切除术中神经保护相关问题[J]. 中国实用外科杂志, 2022, 42(07): 818–822.
[1] 李国新, 陈新华. 全腹腔镜下全胃切除术食管空肠吻合的临床研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 1-4.
[2] 李子禹, 卢信星, 李双喜, 陕飞. 食管胃结合部腺癌腹腔镜手术重建方式的选择[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 5-8.
[3] 李乐平, 张荣华, 商亮. 腹腔镜食管胃结合部腺癌根治淋巴结清扫策略[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 9-12.
[4] 陈方鹏, 杨大伟, 金从稳. 腹腔镜近端胃癌切除术联合改良食管胃吻合术重建His角对术后反流性食管炎的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 15-18.
[5] 许杰, 李亚俊, 韩军伟. 两种入路下腹腔镜根治性全胃切除术治疗超重胃癌的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 19-22.
[6] 李刘庆, 陈小翔, 吕成余. 全腹腔镜与腹腔镜辅助远端胃癌根治术治疗进展期胃癌的近中期随访比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 23-26.
[7] 任佳, 马胜辉, 王馨, 石秀霞, 蔡淑云. 腹腔镜全胃切除、间置空肠代胃术的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 31-34.
[8] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[9] 李博, 贾蓬勃, 李栋, 李小庆. ERCP与LCBDE治疗胆总管结石继发急性重症胆管炎的效果[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 60-63.
[10] 韩戟, 杨力, 陈玉. 腹部形态CT参数与完全腹腔镜全胃切除术术中失血量的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 88-91.
[11] 王露, 周丽君. 全腹腔镜下远端胃大部切除不同吻合方式对胃癌患者胃功能恢复、并发症发生率的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 92-95.
[12] 冯旺, 马振中, 汤林花. CT扫描三维重建在肝内胆管细胞癌腹腔镜肝切除术中的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 104-107.
[13] 王庆亮, 党兮, 师凯, 刘波. 腹腔镜联合胆道子镜经胆囊管胆总管探查取石术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 313-313.
[14] 杨建辉, 段文斌, 马忠志, 卿宇豪. 腹腔镜下脾部分切除术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 314-314.
[15] 叶劲松, 刘驳强, 柳胜君, 吴浩然. 腹腔镜肝Ⅶ+Ⅷ段背侧段切除[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 315-315.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?