超全直肠系膜切除层面的原发性直肠癌和局部复发直肠癌盆腔脏器联合切除中国专家共识(2023版)  

Chinese expert consensus on the pelvic exenteration for primary rectal cancer beyond total mesorectal excision planes and locally recurrent rectal cancer(2023 edition)

作　　者：中国盆腔脏器联合切除协作组 中国医师协会结直肠肿瘤专业委员会 中国医疗保健国际交流促进会胃肠外科学分会 王锡山 汪欣 汤坚强 唐彬(绘图) China PelvEx Collaborative;Colorectal Cancer Committee of the Chinese Medical Doctor Association;Gastrointestinal Surgery Committee of China International Exchange and Promotive Association for Medical and Health Care;Wang Xishan;Wang Xin

机构地区：[1]不详 [2]湘潭市中心医院

出　　处：《中华结直肠疾病电子杂志》2022年第6期441-451,共11页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：国家自然科学基金(81903023,82072732);吴阶平医学基金会临床科研专项资助基金课题(320.6750.2021-04-2);中国医学科学院肿瘤医院“希望之星”人才项目。

摘　　要：超全直肠系膜切除层面的原发性直肠癌(PRC-bTME)和局部复发直肠癌(LRRC)患者经盆腔脏器联合切除手术(PE)治疗后,部分患者可获得长期生存,但需要面临巨大手术创伤、围手术期严重并发症、器官功能永久性丧失及生活质量下降等风险。因此,术前评估应强调多学科协作,制定个体化诊疗措施。应遵循肿瘤功能外科原则和手术损伤效益比原则,强调R0根治切除,降低围手术期并发症发生率,减少外科手术创伤及器官功能丧失,以寻找到最佳的质量控制和平衡点。本共识由中国医师协会结直肠肿瘤专业委员会和中国医疗保健国际交流促进会胃肠外科学分会牵头组织,在总结国内外研究进展及专家经验的基础上形成初稿;经专家组成员讨论、审阅与修改,经过对各项主要观点进行无记名投票,并按照循证医学的原则进行深入论证,最终形成《超全直肠系膜切除层面的原发性直肠癌和局部复发直肠癌盆腔脏器联合切除中国专家共识(2023版)》。本共识主要针对PRC-bTME和LRRC施行PE的适应证、禁忌证、术前诊断评估、围手术期治疗以及PE 的切除范围、手术方式、相关器官的重建、PE的安全性及其并发症、术后随访等问题进行归纳整理,旨在为PRC-bTME和LRRC规范实施PE手术提供指导意见。Pelvic exenteration is often required for primary rectal cancer beyond totalmesorectal excision (PRC-bTME) and locally recurrent rectal cancer (LRRC). Some patients with radical resection can achieve long-term survival, but they need to face risks, such as huge surgical trauma, serious perioperative complications, permanent loss of organ function and decline in quality of life. The preoperative evaluation of PRC-bTME and LRRC should emphasize multidisciplinary collaboration, and develop individualized diagnosis and treatment strategies. The principles of function preservation in oncology surgery and risk-benefit balance should be followed, and R0 resection should be emphasized. Perioperative complications, surgical trauma and organ function loss should be minimized to achieve the best quality control and balance point. This consensus was formulated by the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Gastrointestinal Surgery Committee of China International Exchange and Promotive Association for Medical and Health Care. The draft was formed based on the summary of domestic and foreign research progress and expert experience. After discussion, review and modification by experts, a secret ballot was conducted for each major opinion, and in-depth demonstration was carried out according to the principles of evidence-based medicine. Finally, the Chinese expert consensus on the pelvic exenteration with primary rectal cancer beyond total mesorectal excision planes and locally recurrent rectal cancer (2023 edition) was formed. This consensus mainly summarizes the indications and contraindications of PE for PRC-bTME and LRRC, preoperative diagnosis and evaluation, perioperative treatment, as well as the resection scope, surgical methods, reconstruction of related organs, safety and complications of PE, postoperative follow-up and other issues, in order to provide guidance for PRC-bTME and LRRC to perform PE.

关 键 词：直肠肿瘤 原发性 超全直肠系膜切除层面 肿瘤复发 局部 盆腔脏器联合切除 共识 

分 类 号：R735.37[医药卫生—肿瘤]