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中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (04) : 280 -283. doi: 10.3877/cma.j.issn.2095-3224.2017.04.003

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右半结肠癌D3+CME关键技术
童宜欣1, 龚建平1,()   
  1. 1. 430000 武汉,华中科技大学同济医学院附属同济医院胃肠外科
  • 收稿日期:2017-05-11 出版日期:2017-08-25
  • 通信作者: 龚建平
  • 基金资助:
    国家自然科学基金项目(No:81372324)

The key technology of right hemicolonectomy (D3+CME)

Yixin Tong1, Jianping Gong1,()   

  1. 1. Department of GI Surgery, Tongji Hospital, Tongji Medical College, HUST, Wuhan 430030, China
  • Received:2017-05-11 Published:2017-08-25
  • Corresponding author: Jianping Gong
  • About author:
    Corresponding author: Gong Jianping, Email:
引用本文:

童宜欣, 龚建平. 右半结肠癌D3+CME关键技术[J]. 中华结直肠疾病电子杂志, 2017, 06(04): 280-283.

Yixin Tong, Jianping Gong. The key technology of right hemicolonectomy (D3+CME)[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(04): 280-283.

右半结肠肿瘤的D3和CME术式已经被国内外文献证实能够取得良好的肿瘤学效果,但二者孰优孰劣,一直纷争不断。我们在多年研究的基础上,提出了基于"膜解剖"理论的D3+CME术式,与传统的D3和CME手术相比,D3+CME术式有出血少,淋巴结清扫彻底,系膜切除完整的特点。本文根据笔者的经验,探讨D3和CME术式的优劣,介绍D3+CME术式的操作要点,供有一定手术经验的结直肠外科医生作为参考。

The D3 lymphadenectomy and complete mesocolic excision(CME) of right hemicolonectomy have been proved to have an improved oncological outcome both at home and abroad, but it is still unknown which one is better. The D3+CME we proposed on membrane anatomy have been proved to be less bleeding, more complete lymph node dissection and more complete mesocolic excision. Here we discuss the advantage and disadvantage between D3 and CME, and introduce the key technology in D3+CME.

图1 D3根治原则强调血管根部淋巴结清扫,但系膜的完整性往往被忽略;CME原则强调系膜的完整切除,但清扫范围往往难以达到血管根部;D3+CME原则在保证结肠系膜及其系膜床完整的前提下,清扫范围达到SMA左侧水平
图2 右半结肠系膜分为中央部(central part,C部),上部(upper part,U部)和外侧部(lateral part,L部)三个部分
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