腹腔镜直肠癌前切除术

Laparoscopic anterior resection of rectal carcinoma

基于COLOR II等研究结果,腹腔镜直肠癌手术的地位得以逐步确立。手术切除是直肠癌最重要的治疗方法,对于上段直肠癌,前切除术是标准术式;对于中下段直肠癌,需遵循全直肠系膜切除(TME)的原则,选择低位前切除术或者腹会阴联合切除术。R0切除是手术治疗的核心要素,这包括两层含义:其一是淋巴结清扫范围需要达到D2水平,其二是标本的远、近端切缘以及环周切缘均需为阴性。准确地解剖出肠系膜下动脉、左结肠动脉以及直肠上动脉,是保证淋巴清扫范围的基础,循"神圣平面"解剖分离直肠系膜是环周切缘阴性和标本完整的保证。

Based on the results of COLOR II research,the status of laparoscopic surgery for rectal cancer has been established. Surgical resection is the most important treatment for rectal cancer. Anterior resection is the standard procedure for the removal of tumors in the upper rectum. For middle or lower rectal cancer,principles of total mesorectal excision（ TME） should be followed, and anterior resection or abdominal-perineal resection could be used. R0 resection is the core element in addition to dissection of D2 lymph nodes. Accurate dissection of the inferior mesenteric artery,left colonic artery and superior rectal artery ensure the extent of lymph node dissection. Using the ＂ holy plane＂ to dissect the mesorectum is the assurance of negative circumferential resection margin and complete specimens.