中国实用外科杂志

中国实用外科杂志

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右半结肠癌D3淋巴结清扫范围及入路选择

冯    波，周乐其   

  1. 上海交通大学医学院附属瑞金医院胃肠外科 上海市微创外科临床医学中心，上海200025
  • 出版日期:2020-03-01 发布日期:2020-03-18

  • Online:2020-03-01 Published:2020-03-18

摘要： 完整结肠系膜切除（CME）与D3淋巴结清扫均强调高位结扎供血血管及系膜切除的完整性，进一步规范了结肠癌根治术，且一定程度上改善了病人预后，但在具体的清扫范围和手术入路选择上仍存较大争议。争议焦点主要集中于D3淋巴结清扫的内侧界，目前主流的观点是以肠系膜上静脉（SMV）左侧缘为边界，但亦有SMV右侧、SMA左侧、SMA中线等多种不同的观点。对于胃结肠韧带淋巴结（GCLN）或幽门下淋巴结的清扫，虽无高级别循证医学证据的支持，亦有多种不同意见。此外，腹腔镜右半结肠癌D3根治术有多种手术入路的选择，尚需更多临床研究的论证。

关键词: 右半结肠癌, D3淋巴结清扫, 完整结肠系膜切除, 手术入路

Abstract: The extent of D3 lymph node dissection and choice of surgical approached for right colon cancer surgery                     FENG Bo,ZHOU Le-qi.  Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine; Shanghai Minimally Invasive Surgery Center, Shanghai 200025, China
Corresponding author: FENG Bo, E-mail：fengbo2022@163.com
Abstract    Both complete mesocolic excision（CME）and D3 lymphadenectomy emphasize the high-ligation of feeding vessels and integrity of mesocolon，and have contributed to the standardization of colon cancer surgery and improved patient's prognosis to a certain extent. However，the exact extent of lymph node dissection and appropriate surgical approach are still debatable.The main dispute lies on the medial border of D3 lymph node dissection.At present，the mainstream view places the medial border on the left side of the SMV，but there were also many other views such as the right side of the SMV，the left side of the SMA，and midline of the SMA.Although there is no high-level evidence for the dissection of gastrocolic ligament lymph nodes（GCLN）or subpyloric lymph nodes，opinions differed at the necessity to dissect those lymph nodes.In addition，laparoscopic D3 lymphadenectomy for right colon cancer has a variety of surgical approaches，and more clinical studies are needed to demonstrate it.

Key words: right colon cancer, D3 lymphadenectomy, complete mesocolic excision, surgical approach