右半结肠癌手术中国专家共识(2024版)  

Chinese expert consensus on the surgical treatment of right-sided colon cancer(2024 edition)

作　　者：中华医学会外科学分会结直肠外科学组 中国结直肠临床研究协作组 肖毅[2] 臧潞[3] 张忠涛[4] 池畔[5] 徐徕[6] 陆君阳[6] 赵轩[7] Chinese Society of Colorectal Surgery;Chinese Colorectal Research Consortium,CCRC;Xiao Yi;Zang Lu;Zhang Zhongtao;Chi Pan(不详;Division of Colorectal Surgery,Department of General Surgery,Peking Union Medical College Hospital,Beijing 100730,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Colorectal Surgery,the Affiliated Union Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]不详 [2]中国医学科学院北京协和医学院、北京协和医院基本外科结直肠专业组,北京100730 [3]上海交通大学医学院附属瑞金医院普通外科,上海200025 [4]首都医科大学附属北京友谊医院普通外科,北京100050 [5]福建医科大学附属协和医院结直肠外科,福州350001 [6]北京协和医院 [7]上海交通大学医学院附属瑞金医院

出　　处：《中华胃肠外科杂志》2024年第9期879-890,共12页Chinese Journal of Gastrointestinal Surgery

基　　金：中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-A-001)。

摘　　要：近20年来,随着腹腔镜技术的发展和应用以及完整结肠系膜理念的推广,右半结肠癌手术的技术和理念已经发生了较大的变化。近年来,世界范围内关于右半结肠手术的高质量临床研究开展和循证医学证据,为右半结肠癌手术的争议问题达成共识提供理论支撑。鉴于此,中华医学会外科学分会结直肠外科学组和中国结直肠临床研究协作组牵头,组织全国结直肠外科专家,就右半结肠癌手术的14项关键临床问题,结合我国医生及患者的偏好和干预措施的利弊,形成中国专家共识,以期规范右半结肠癌手术。共识主要包含以下三方面内容:(1)手术解剖:概括右半结肠癌手术系膜、筋膜、间隙、血管分支的结构和定义;并推荐肠系膜上动脉的左侧界作为CME手术的内侧界。(2)手术方式:推荐腹腔镜作为初始可切除右半结肠癌手术的首选手术方式。(3)手术原则:标准D2手术可作为右半结肠癌的常规手术方式。但术前影像评估和术中探查可疑区域淋巴结转移患者可考虑行完整结肠系膜切除术(CME)。除非考虑存在幽门下淋巴结转移,否则不建议常规行幽门下淋巴结清扫。此外,共识还对血管离断部位、肠管切除范围和消化道重建方式进行了推荐。In the past two decades,with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision,significant changes have occurred in the surgical treatment of right-sided colon cancer.The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium(CCRC)Organized national experts incolorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy,taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures,with a view to standardizing the surgical treatment of right colon cancer.The consensus recommendations were focused on three main aspects:(1)surgical anatomy:the key structures and its definitions related to the mesentery and vascular anatomy were clarified.It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision;(2)surgical technique:laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer;(3)surgical principles:D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer.Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis.Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis.Additionally,consensus recommendations were made regarding the location of vascular ligation,the extent of bowel resection,and anastomosis techniques.

关 键 词：结肠肿瘤 右半结肠 手术 全结肠系膜切除 

分 类 号：R735.35[医药卫生—肿瘤]