腹腔镜右半结肠癌根治术的标准化流程和质量控制

Standardized procedures and quality control in laparoscopic right hemicolectomy for right-sided colon cancer

腹腔镜右半结肠切除术是目前治疗右半结肠癌最常用的手术方式,其在手术切除范围、淋巴结清扫范围、消化道重建等关键技术上趋于成熟,但仍缺乏标准化的手术流程及质量控制体系.在COLORⅣ研究(1项对比腹腔镜右半结肠癌根治术中腹腔内吻合与腹腔外吻合疗效的国际多中心随机对照研究)的前期筹备阶段,笔者团队基于德尔菲法调查结果制订腹腔镜右半结肠癌根治术标准化流程,形成手术能力及质量评估工具,目前正尝试利用人工智能实现该手术技能评价的自动化.笔者希望通过上述工作,帮助结直肠外科医师规范手术操作,减少手术并发症,为多中心临床研究的同质化提供支持,同时推动该手术结构化培训的实施.

Laparoscopic right hemicolectomy is currently the most commonly used surgical procedure for right-sided colon cancer.Although this procedure is maturing in terms of key tech-niques such as the extent of surgical resection,the extent of lymph node dissection,and the recons-truction of digestive tract,it still lacks a standardized surgical procedure and quality control system.In the pre-preparation phase of the COLORⅣstudy(an international,multicenter,randomized contro-lled trail comparing the efficacy of intracorporeal anastomosis versus extracorporeal anasto-mosis in laparoscopic right hemicolectomy for right-sided colon cancer),the research team of the authors formulates a standardized procedure for laparoscopic right hemicolectomy based on the Delphi survey,and develops a competency assessment tool for surgical ability and quality.Attempts are being made to automate the evaluation of surgical techniques using artificial intelligence.It is hoped that the above work will help colorectal surgeons to standardize surgical operations and reduce complications,provide support for the homogenization of multicenter clinical studies,and promote the implementation of structured training for this procedure.