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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

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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]. 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]. 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
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