腹腔镜完整结肠系膜切除术的应用和评价

Laparoscopic complete mesocolic excision for colon cancers

精细和微创是现代外科手术的两大主题。腹腔镜技术由于其创伤小、患者术后恢复迅速等优势,自20世纪90年代以来在结直肠手术中得到了快速的发展和应用。2008年美国国家综合癌症网络(NCCN)确认了腹腔镜结肠手术的可行性。完整结肠系膜切除术(CME)作为结肠癌高质量的根治手术,遵循精细解剖,精准手术的理念。2011年NCCN已将CME手术作为局部进展期结肠癌的规范化手术。腹腔镜CME手术结合了结肠手术的两大优势,但是由于CME手术对于手术质量要求更高,手术医生学习曲线更长,目前对于其在临床中的应用还处在探讨阶段。现有的证据显示腹腔镜CME手术可以达到与开腹CME手术治疗结肠癌一致的根治效果,但是需要严格掌握好其适用范围,以使患者获益最大化。

Fine operation and minimal invasion are the main features of modern surgery. For the advantages of minor injury and rapid postoperative recovery,laparoscopic techniques have been used widely in colorectal surgery since the 1990 s. Moreover,the feasibility of laparoscopic colectomy was confirmed by the National Comprehensive Cancer Network（ NCCN） in 2008. Complete mesocolic excision（ CME） is a high-quality procedure based on fine surgical dissection and precise surgical concept. The NCCN recommended it as a standardized surgical procedure for locally advanced colon cancer in 2011. Laparoscopic CME has the above advantages theoretically; however it is used in the early stage with high requirements. The current reports suggested that laparoscopic CME could achieve the similar as open surgery for colon cancer.To maximize benefits for the pateints,laparoscopic CME should be operated on under strict indications.