腹腔镜右半结肠癌根治术的争议和手术技巧

Controversies and surgical techniques in the laparoscopic radical resection for right colon cancer

右半结肠癌是一类临床常见的恶性肿瘤,手术切除为主要治疗手段,也是患者唯一治愈希望。近年来手术方式的改进是结肠癌外科治疗领域的热点之一。开展腹腔镜手术还是传统开放手术、肠段切除范围、施行D3根治术还是全结肠系膜切除术、选择动脉导向还是静脉导向、幽门下淋巴结(第6组淋巴结)是否清扫等问题一直存在争议,且多数问题目前尚缺乏前瞻性随机对照研究论证。同时,鉴于腹腔镜右半结肠癌根治术较为复杂、并有较大的手术风险。因此,笔者查阅相关文献并结合自身临床经验,根据以上几点争议,就如何规范开展腹腔镜右半结肠癌根治术进行讨论。

Right colon cancer is a kind of clinically common colorectal cancer. Surgical resection is the main treatment and the only curative method for patients. Improvement of surgical methods in recent years is one of the hotspots in the surgical treatment of colorectal cancer. There are controversies in laparoscopic surgery or traditional open surgery, intestine resection extent, D3 radical surgery or complete mesocolic excision, selective arterial guidance or venous guidance, pyloric lymph nodes (No.6 group lymph nodes) dissection, and most of the issues are currently lacking of prospectively randomized controlled trials. Therefore, this article discusses the above problems. At the same time, in view of the complicated operation of right hemicolectomy, and the greater risk of surgery, the author consulted the relevant literature and combined his clinical experience to introduce the key techniques of the operation.