不断提高腹腔镜右半结肠癌D3根治术的规范化  

Continuous improvement in the standardization of laparoscopic D3 dissection in patients undergoing laparoscopic colectomy for right colon cancer

作　　者：姚宏伟[1] 魏鹏宇 高加勒 张忠涛[1] Yao Hongwei;Wei Pengyu;Gao Jiale;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,National Key Laboratory of Digestive Health,Clinical Practice and Research Center for Colorectal Neoplasm,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,国家消化系统疾病临床医学研究中心,消化健康全国重点实验室,首都医科大学结直肠肿瘤临床诊疗与研究中心,北京100050

出　　处：《中华普外科手术学杂志（电子版）》2024年第1期1-4,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：国家科技支撑计划项目(2015BAI13B09);国家重点研发计划资助项H(2017YFC0110904);北京市医院管理局临床医学发展专项基金项H(ZYLX201504);首都医科大学结直肠肿瘤临床诊疗与研究中心基金项目(1192070313);首都医科大学附属北京友谊医院科研启动基金项目(YYQDKT2016-5)。

摘　　要：腹腔镜右半结肠癌切除术从单纯的器官切除,发展为以血管为核心的根治性切除,再到基于膜解剖理念的D3淋巴结清扫及全结肠系膜切除(complete mesocolic excision,CME)。虽然手术技术日趋成熟,但手术难度较大,且在吻合方式的选择等细节问题上存在争议,手术流程尚待进一步规范化。手术技术的同质性是外科多中心研究的关键,笔者中心基于“腹腔镜右半结肠切除术腹腔内吻合对比腹腔外吻合的国际多中心随机对照研究(COLORⅣ研究)”前期筹备阶段完成的2轮德尔菲调查,牵头制定了腹腔镜右半结肠癌根治术的标准化流程及质量控制要点,并形成了手术能力及质量评估工具。本文将对腹腔镜右半结肠癌D3根治术的流程及关键步骤展开讨论,望能帮助国际结直肠外科医师规范手术操作,减少手术并发症,并为促进多中心临床研究的同质化提供支持,同时推动该手术结构化培训的实施。Laparoscopic right colectomy(LRC)for colon cancer has evolved from pure organ resection,to radical resection based on vascular anatomy,to D3 lymph node dissection and complete mesocolic excision(CME)based on membrane anatomy.Although the surgical technique is becoming more mature,the procedure is difficult and controversial in details such as the choice of anastomosis,and the surgical procedure is yet to be further standardized.The homogeneity of the surgical technique is the key to multicenter surgical research.Based on the results of the 2 rounds of the Delphi survey conducted during the preparatory phase of the COLORⅣstudy(a multicenter randomized clinical trial comparing intracorporeal and extracorporeal ileocolic anastomosis after LRC for colon cancer),the author's team discussed the standardized procedure and quality control points for LRC.And a competency assessment tool(CAT)for right colon cancer surgery was ultimately developed.This article will discuss the process and key steps of this procedure.It is hoped that this will help international colorectal surgeons to standardize surgical operations,reduce surgical complications,support the homogenization of multicenter clinical studies,and promote the implementation of structured training for this procedure.

关 键 词：结肠肿瘤 右半结肠癌根治术 质量控制 临床研究 

分 类 号：R735.35[医药卫生—肿瘤]