腹腔镜结直肠癌手术关键技术标准及评价  

Standardization and assessment of the key techniques in laparoscopic surgery for colorectal cancer

作　　者：姚宏伟[1] 宋建宁[1] 魏鹏宇 张忠涛[1] YAO Hongwei;SONG Jian-ning;WEI Peng-yu(Department of General Surgery,Bejing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Diseases,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：《中国实用外科杂志》2024年第1期66-69,共4页Chinese Journal of Practical Surgery

基　　金：国家科技支撑计划项目(No.2015BAI13B09);国家重点研发计划资助项目(No.2017YFC0110904);北京市医院管理中心扬帆计划临床技术创新项目(No.ZLRK202302);首都医科大学结直肠肿瘤临床诊疗与研究中心基金项目(No.1192070313)。

摘　　要：多项大型临床研究已证实腹腔镜结直肠癌手术的安全性和有效性,腹腔镜已成为我国结直肠癌外科治疗的主要方式。如今,腹腔镜结直肠癌手术技术仍在持续优化和改进,其关键技术主要围绕以下3方面:(1)完整的手术切除范围。(2)合适的淋巴结清扫范围。(3)安全的消化道重建。直肠癌手术应遵循全直肠系膜切除(TME)的原则,保证直肠系膜的完整性和环周切缘的阴性,对于直肠上动脉根部和侧方淋巴结的清扫,应根据肿瘤的浸润深度和转移情况进行选择性切除。结肠癌手术应遵循完整结肠系膜切除(CME)的理念,将结肠脏层筋膜从壁层筋膜完整分离,清扫至第3站淋巴结,提高淋巴结检出率和降低局部复发率。结肠癌肠管切除范围,应满足清扫区域转移淋巴结的要求,参考欧美的“10 cm原则”或日本的“10+5”原则。淋巴结清扫范围应根据肿瘤的部位、分期、转移情况和术前影像学检查等因素进行个体化决策。消化道重建是腹腔镜结直肠癌手术的重要组成部分,规范的消化道重建对于提高手术成功率、降低手术并发症发生率、促进病人术后康复等具有重要意义。推动手术的规范化开展、形成科学的手术技术评价工具、开展高质量的临床研究,是提高我国腹腔镜结直肠癌手术规范化水平的关键。Several large-scale clinical studiesh ave confirmed the safety and effectiveness of laparoscopic surgery for colorectal cancer,and laparoscopy has become the main modality of colorectal cancer surgical treatment in China.Nowadays,laparoscopic colorectal surgical techniques are still being continuously optimized and improved,and its key techniques are mainly reflected in the following three aspects:(1)complete surgical resection range,(2)appropriate lymph node dissection range,(3)safe digestive tract reconstruction.Rectal cancer surgery should adhere to the principles of total mesorectal excision(TME),ensuring the integrity of the mesorectum and negative circumferential margins.Selective resection of the root of the superior rectal artery and lateral lymph nodes should be based on the depth of tumor infiltration and metastasis.Colon cancer surgery should follow the concept of complete mesocolic excision(CME),involving the complete separation of the colonic visceral fascia from the parietal fascia,clearing up to the third-tier lymph nodes,thereby increasing lymph node retrieval rates and reducing local recurrence rates.The extent of colon resection in colon cancer should meet the requirements of clearing the area of metastatic lymph nodes,following either the Western 10 cm principle or the Japanese'10+5'principle.Personalized decisions regarding lymph node dissection should consider factors such as tumor location,staging,metastasis,and preoperative imaging.Gastrointestinal tract reconstruction is a crucial component oflaparoscopiccolorectal cancer surgery.Standardized reconstruction plays a significant role in improving surgical success rates,reducing the incidence of surgical complications,and promoting postoperative patient recovery.recovery.Advancing standardized surgical practices.establishing scientifc surgical technique assessment tools,and conducting high-quality clinical research are crucial for elevating the standardization level of laparoscopie colorectal cancer surgery in our country.

关 键 词：腹腔镜手术 结直肠癌 手术操作 标准化 质量控制 

分 类 号：R6[医药卫生—外科学]