以供应血管为导向的结直肠癌根治术中系膜边缘的探讨

Study on mesentary margin in supply vessel-oriented radical resection of colorectal cancer

外科根治术中的理念经历了从血管解剖导向、淋巴结清扫导向到整块切除导向的3个阶段,而目前以系膜为导向的手术方式已经发展为新的认识层面。对于系膜的认识,有很多经典的理论,从“肠系膜是一个包裹的复合结构”,到“肠系膜是一个器官”,再到“广义系膜理论”,但都没有明确提出系膜的界限标志。基于国内外各类膜解剖理论的基础,我们总结定义了结直肠癌根治术中系膜切除的3个边界,即系膜的侧边界是供应血管为导向的肠管切除边界及其系膜、底边界是系膜床以及中央边界是淋巴结根治程度。通过对切除系膜的细化阐述,有助于不同期别肿瘤根治术的系膜边缘的准确界定。

The concept of radical surgery has experienced from vascular anatomy guidance,lymph node dissection guidance to en-bloc resection guidance.At present,the mesentery guided surgery has developed to a new level of understanding.There are many classical theories on the understanding of the mesentery,from"the mesentery is a wrapped composite structure"to"the mesentery is an organ"and then to"the generalized mesentery theory",but they do not clearly put forward the boundary mark of the mesentery.On the basis of various membrane anatomy theories at home and abroad,we summarized and defined three boundaries of mesenteric excision in radical resection of colorectal cancer.The lateral boundary of the mesentery is the intestinal resection boundary and its mesentery oriented by supplyvessel,the bottom boundary is the mesentery bed,and the central boundary is the degree of lymph node radical resection.Through the detailed description of the mesentery excision,it is helpful to accurately define the mesenteric margin in different stages of radical resection of tumors.