中国实用外科杂志

中国实用外科杂志

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基于COLOR Ⅳ研究分析腹腔镜右半结肠癌根治术的标准化流程和质量控制要点

姚宏伟1，Jurriaan Tunmann2，张忠涛1，Jaap Bonjer2   

  1. 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；2阿姆斯特丹大学医学中心外科，荷兰阿姆斯特丹 
  • 出版日期:2023-10-01

  • Online:2023-10-01

摘要： 手术技术的同质性是外科多中心研究的关键，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（COLOR Ⅳ研究）”前期筹备阶段完成的2轮德尔菲调查结果，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，最终形成了手术能力及质量评估工具，将该手术分为6个模块：（1）建立腹部手术环境。（2）游离右结肠后间隙及右半结肠。（3）显露与结扎结肠血管，或寻找肠系膜上血管并打开血管鞘，清扫淋巴结。（4）游离横结肠后间隙及解剖Henle干。（5）打开胃结肠韧带与寻找系膜间间隙。（6）移除标本及消化道重建。希望通过COLOR Ⅳ研究为国际结直肠外科医师规范手术操作，减少手术并发症，为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。

关键词:  , 腹腔镜手术, 右半结肠癌根治术, 手术操作, 标准化, 质量控制, COLOR Ⅳ研究

Abstract: Standardized procedures and quality control points for laparoscopic radical resection for right colon cancer based on COLORⅣ research        YAO Hong-wei*, Jurriaan Tunmann, ZHANG Zhong-tao, et al. *Department of General Surgery, Beijing 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
Corresponding authors: ZHANG Zhong-tao, E-mail:zhangzht@
ccmu.edu.cn; Jaap Bonjer,E-mail: j.bonjer@amsterdamumc.nl
Abstract    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 pre-preparatory phase of the COLOR Ⅳ study （a multicenter randomized clinical trial comparing intracorporeal and extracorporeal ileocolic anastomosis after laparoscopic right colectomy for colon cancer）, the author's team discussed the standardized procedure and quality control points for laparoscopic right colectomy. A competency assessment tool for right colon cancer surgery was ultimately developed, which categorized the procedure into 6 panels:（1）establishment of the abdominal surgical environment;（2）expanding the right retrocolic space (RRCS) and right colon freeing;（3）colon vascularization and ligation, or supra mesenteric vascular search and vascular sheath opening, and lymph node dissection;（4）handling of the Henle's trunk and transverse retrocolic space (TRCS);（5）gastrocolic ligament opening and intermembranous space (IMS) finding;（6）specimen removal and digestive tract reconstruction. It is hoped that this article will help colorectal surgeons standardize their surgical practices, reduce surgical complications, provide support for the homogeneity of multicenter clinical studies, and promote the implementation of structured training for this procedure.

Key words: laparoscopic surgery, radical right colectomy, surgical procedure, standardization, quality control, COLOR Ⅳ research