摘要
根据多中心随机对照试验(MRCT)研究证明,结肠癌腹腔镜下根治手术与传统的开腹手术具有相同的近、远期临床疗效。腹腔镜下右半结肠癌根治手术重要的是根部胚胎发生的平面进行分离和中枢血管根部结扎、切断。只有沿着膜间隙分离才可以做到无血、微创、保证切除系膜完整和避免体内筋膜和脏器副损伤。右半结肠的系膜分布与胃系膜相邻,与小肠系膜相连,胰十二指肠位于右半结肠系膜与后腹膜下筋膜之间,尤其胰十二指肠前、后Treitz筋膜与Toldt间隙的关系比较复杂,与能否做到完整结肠系膜切除(CME)手术有密切关系。本文从右半结肠的系膜分布范围、Toldt筋膜的定义、右半结肠系膜在膜床上的分区、淋巴结清扫范围以及膜间隙与CME的关系等方面进行了探讨。同时,根据目前CME手术存在的问题,分享了术中如何准确地寻找膜间隙的经验体会,并根据"膜"手术的经验,提出了手术大体标本评估的中山逸仙标准,以供同道对右半结肠癌根治性CME手术参考。
According to multicenter randomized controlled trials, laparoscopic radical resection of colon cancer has the same short and long term clinical efficacy as traditional open surgery. In laparoscopic radical resection of right semicolon cancer, it is important to separate the embryonic plane of the root, and to ligate and cut off the central vascular roots. Only by separation along the membrane space can one achieve minimally invasive operation with no bleeding, and ensure the integrity of the excision of the mesangium and avoid damage of internal fascia and other organs. The mesangial distribution of the right semicolon is adjacent to the mesangium of the stomach and is connected to the mesentery of the small intestine. The pancreaticoduodenum locates between the right semicolon mesentery and the retroperitoneal subperitoneal fascia. In particular, the relationship between the anterior and posterior Treitz fascia of the pancreaticoduodenum and the Toldt space is complex, which is closely related to the feasibility of complete mesocolic excision(CME). This article introduces the distribution of intermembranous space and mesangial bed in the right semicolon, presenting the problem in CME surgery. In addition, there are key points in identifying the gap between the membranes based on the author’s experience and we propose a new evaluation criteria for membrane surgical specimens, which has certain guiding significance for radical CME surgery for right semicolon cancer.
作者
韩方海
钟广宇
Han Fanghai;Zhong Guangyu(Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2019年第5期436-440,共5页
Chinese Journal of Gastrointestinal Surgery
基金
国家卫生计生委医药卫生科技发展项目(W2015JZC01).
