结肠癌完整结肠系膜切除——规范化质量控制手术的趋势

Complete mesocolic excision:a new trend of standardization of colon cancer surgery with high quality

全直肠系膜切除已成为直肠癌手术中应用最广泛的全球化规范治疗手段,但结肠癌手术目前尚缺乏规范化手术方式。完整结肠系膜切除作为结肠癌规范化手术的新理念由德国Hohenberger首次提出,该术式以胚胎解剖学为基础,更符合肿瘤学特点,后续研究发现该术式可改善预后,降低局部复发率,并不增加术后并发症发生率。完整结肠系膜切除的手术要点主要包括:锐性分离脏层、壁层筋膜;中央血管根部结扎;确保合理淋巴结清扫范围。结肠系膜完整切除术的提出是结肠癌外科治疗观念的更新,在经多中心前瞻性研究证实后,有可能成为大肠癌手术又一新的手术典范。

Total mesorectal excision has become the most widely standardization surgical technique of rectal cancer in the world, but it is still lack of standardized operation for colon cancer. Complete mesocolic excision as a new concept in colon cancer surgery was first proposed by professor Hohenberger from German, which corresponded to the feature of the tumor and was based on the embryology and anatomy. Some research about complete mesocolic excision showed that the procedure could improve the prognosis, decrease the local recurrence of the tumor without more complication. The key points of complete mesocolic excision are as below： dissecting sharply between the visceral fascia and parietal fascia, highly ligaturing the supplying vessel, guaranteeing the reasonable lymphadenectomy areas. Complete mesocolic excision might become a new standardized operation of colorectal cancer based on the random prospective clinical trial in multiple centers.