结肠癌完整结肠系膜切除术的实践与技术  

Technique of complete mesocolic excision of colon cancers

作　　者：叶颖江[1] 申占龙[1] 王杉[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华普外科手术学杂志（电子版）》2012年第2期4-7,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：首都临床特色应用研究项目(Z111107058811046)

摘　　要：全直肠系膜切除术(TME)已被公认为是直肠癌的标准化手术技术,但结肠癌手术尚缺乏标准化手术技术。2009年,德国外科医生Hohenberger提出了完整结肠系膜切除术(CME)的概念,认为结肠与直肠周围存在的解剖平面相似,也存在脏壁层筋膜及两者间的疏松无血管间隙,沿该间隙锐性分离,可获得被脏层筋膜完整包被的整个结肠系膜。掌握结肠胚胎发育和解剖是开展CME的前提和基础。CME技术以确保结肠系膜完整、中央血管高位结扎为操作要点。目前多数循证医学证据认为该技术有更好的肿瘤学优势,为CME技术的推广提供了科学依据。北京大学人民医院胃肠外科在国内积极实践推广CME技术,并对CME手术切除范围、淋巴结清扫范围、手术适应证选择、应用解剖等进行了探讨和系列的临床科学研究。Total mesorectal excision （TME） is considered as a standardization of rectal cancer surgery. However, colon cancer lacks standardized surgical procedures by now. In 2009, Hohenberger proposed a new conception of complete mestocolic excision （ CME ）, and deemed that there was a same ＇non-blood＇ operative plane between the visceral and parietal fascia of the colon as rectum, and that dissection along this plane could acquire the complete mesocolon being covered by the visceral fascia. Knowledge about the development and anatomy of the colon is the premise to carry out CME, which emphasizes on the separation of the mesocolon from the parietal plane and true central ligation of the supplying vessels right at their roots. The Department of Gastroenterological Surgery of Peking University People＇ s Hospital has conducted studies on CME including surgical range, lymph node dissection, operative indications and anatomy of CME, which would popularize the CME procedures of colon cancer in China.

关 键 词：结肠肿瘤 肿瘤复发 局部 结肠系膜 完整结肠系膜切除术 

分 类 号：R735.35[医药卫生—肿瘤]