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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2019, Vol. 08 ›› Issue (06) : 627 -630. doi: 10.3877/cma.j.issn.2095-3224.2019.06.015

所属专题： 文献；

综述

结肠癌CME与D3根治术：平面与血管之争
黄泉龙1, 金英虎1, 王贵玉1,†()   
  1. 1. 150000　哈尔滨医科大学附属第二医院结直肠肿瘤外科
  • 收稿日期:2018-12-27 出版日期:2019-12-25
  • 通信作者: 王贵玉
  • 基金资助:
    吴阶平医学基金会(No. 320.6750.15183)

Radical resection of colon cancer with CME and D3: controversy between plane and blood vessel

Quanlong Huang1, Yinghu Jin1, Guiyu Wang1,†()   

  1. 1. Department of Colorectal Cancer Surgery, Second Affiliated Hospital of Harbin Medical University, Harbin 150000, China
  • Received:2018-12-27 Published:2019-12-25
  • Corresponding author: Guiyu Wang
  • About author:
    Corresponding author: Wang Guiyu, Email:
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黄泉龙, 金英虎, 王贵玉. 结肠癌CME与D3根治术：平面与血管之争[J]. 中华结直肠疾病电子杂志, 2019, 08(06): 627-630.

Quanlong Huang, Yinghu Jin, Guiyu Wang. Radical resection of colon cancer with CME and D3: controversy between plane and blood vessel[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2019, 08(06): 627-630.

目前，大量的回顾性研究证实对结肠癌患者行结肠癌完整系膜切除（CME）和D3根治术是可行的并且均有较理想的预后，可降低肿瘤复发率以及提高五年生存率。较传统手术，患者从结肠癌CME和D3根治术中可获得更大受益。但结肠癌CME和D3根治术两者由于概念与手术强调重点不同，在临床应用中存在着争议。本文主要根据结肠癌CME和D3根治术的方法以及国内外大量相关文献的报道进行阐述。

关键词: 结肠肿瘤, CME, D3根治术

At present, a large number of retrospective studies confirmed colon cancer complete mesocolic excision (CME) and D3 resection are feasible and ideal, which could reduce the recurrence rate and improve the 5-year survival rate. Compared with traditional surgery, patients could benefit more from CME and D3 colon cancer resection. However, there are controversies in the clinical application of colon cancer CME and D3 radical operation because of the different emphasis on the concept and operation. This article is mainly about the methods of CME and D3 radical resection of colon cancer and the reports of a large number relevant literature.

Key words: Colonic neoplasms, CME, D3 radical resection
图1 根据日本结肠直肠癌协会（Japanese Society for Cancer of the Colon and Rectum，JSCCR）淋巴结分级，D1淋巴结以红色表示，D2淋巴结以蓝色表示，D3淋巴结以黄色表示（修改自日本指南[16,17]）
图2 结肠切除和淋巴结清扫范围[8]。JSCCR推荐（红色），Hohenberger提出的CME联合CVL（蓝色）
[1]
陈万青，孙可欣，郑荣寿. 2014年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤，2018，27(1)：1-14.
[2]
陆爱国，宗雅萍.腹腔镜右半结肠癌D3根治术[J].外科理论与实践, 2014, 19(2): 104-107.
[3]
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy) [J]. Surg Laparosc Endosc, 1991, 1(3): 144-150.
[4]
Feng B, Sun J, Ling TL. Laparoscopic complete mesocolic excision (CME) with medial access for right-hemi colon cancer: feasibility and technical strategies [J]. Surg Endosc, 2012, 26(12): 3669-3675.
[5]
房学东，陈学博，季福建. 腹腔镜右半结肠癌根治规范化相关问题［J/CD］.中华普外科手术学杂志：电子版，2015，9(1)：18-22.
[6]
Hohenberger W, Weber K, Matzel K. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation-technical notes and outcome [J]. Colorectal Dis, 2010, 11(4): 354-364.
[7]
Shin JW, Amar AH, Kim SH. Complete mesocolic excision with D3 lymph node dissection in laparoscopic colectomy for stages Ⅱ and Ⅲ colon cancer: long-term oncologic outcomes in 168 patients [J]. Tech Coloproctol, 2014, 18(9): 795-803.
[8]
Pedrazzani C, Lauka L, Sforza S. Management of nodal disease from colon cancer in the laparoscopic era [J]. Int J Colorectal Dis, 2015, 30(3): 303-314.
[9]
龚建平.右半结肠癌根治术的外科膜解剖[J/CD].中华结直肠疾病电子杂志, 2015, 4(6): 600-601.
[10]
Abdelkhalek M, Setit A, Bianco F. Complete mesocolic excision With central vascular ligation in comparison With conventional surgery for patients with colon cancer-the experiences at two centers [J]. Ann Coloproctol, 2018, 34(4): 180-186.
[11]
Panaccio P, Grottola T, Ricciardiello M. How we do it: totally laparoscopic complete mesocolon excision for splenic flexure cancer [J]. Langenbecks Arch Surg, 2018, 403(6): 769-775.
[12]
Bertelsen CA, Elfeki H, Neuenschwander AU. The risk of long-term bowel dysfunction after resection for sigmoid adenocarcinoma: a cross-sectional survey comparing complete mesocolic excision with conventional surgery [J]. Colorectal Dis, 2018, 20(9): O256-O266.
[13]
Bernhoff R, Sjövall A, Buchli C. Complete mesocolic excision in right-sided colon cancer does not increase severe short-term postoperative adverse events [J]. Colorectal Dis, 2018, 20(5): 383-389.
[14]
Kobayashi H, West NP, Takahashi K. Quality of surgery for stage III colon cancer: comparison between England,Germany, and Japan [J]. Ann Surg Oncol, 2014, 21(3): 398-404.
[15]
林锋，李勇. 腹腔镜右半结肠癌根治术[J].中国实用外科杂志, 2011, 31(9): 861-866.
[16]
Watanabe T, Itabashi M, Shimada Y. Japanese society for cancer of the colon and rectum (JSCCR) guidelines 2010 for the treatment of colorectal cancer [J]. Int J Clin Oncol, 2012, 17(1): 1-29.
[17]
Japanese Society for Cancer of the Colon and Rectum. Japanese classification of colorectal carcinoma [S]. 2nd English Edition, Tokyo: Kanehara, 2009.
[18]
Kanemitsu Y, Komori K, Kimura K. D3 Lymph node dissection in right hemicolectomy with a no-touch isolation technique in patients with colon cancer [J]. Dis Colon Rectum, 2013, 56(7): 815-824.
[19]
Hashiguchi Y, Hase K, Ueno H. Optimal margins and lymphadenectomy in colonic cancer surgery [J]. Br J Surg, 2011, 98(8): 1171-1178.
[20]
West NP, Kobayashi H, Takahashi K. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation [J]. J Clin Oncol, 2012, 30(15): 1763-1769.
[21]
Xie D, Yu C, Gao C, et al. An optimal approach for laparoscopic D3 lymphadenectomy plus complete mesocolic excision (D3＋CME) for right-sided colon cancer [J]. Ann Surg Oncol, 2017, 24(5): 1312-1313.
[22]
West NP, Hohenberger W, Weber K. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon [J]. J Clin Oncol, 2010, 28(2): 272-278.
[23]
叶颖江，高志冬，王杉. 腹腔镜完整结肠系膜切除术的应用和评价[J/CD].中华普外科手术学杂志：电子版，2015，9(1)：14-17.
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