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中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (05) : 507 -511. doi: 10.3877/cma.j.issn.2095-3224.2020.05.013

所属专题: 文献

综述

右半结肠癌淋巴结清扫范围的临床研究进展
刘赛靓1, 周勇2, 俞旻皓1, 钟鸣1,()   
  1. 1. 200127 上海交通大学医学院附属仁济医院胃肠外科
    2. 201800 上海嘉定中医医院外科
  • 收稿日期:2020-04-01 出版日期:2020-10-25
  • 通信作者: 钟鸣
  • 基金资助:
    国家自然科学基金(No.81702300,No.81873555)

The extent of lymph node excision in right hemicolectomy: a clinical review of the progression in lymphadenectomy

Sailiang Liu1, Yong Zhou2, Minhao Yu1, Ming Zhong1,()   

  1. 1. Department of Colorectal Surgery, Renji Hospital, School of Medicine, Jiaotong University, Shanghai 200127, China
    2. Department of Surgery, Jiading Hospital of Traditional Chinese Medicine, Shanghai 201800, China
  • Received:2020-04-01 Published:2020-10-25
  • Corresponding author: Ming Zhong
  • About author:
    Corresponding author: Zhong Ming, Email:
引用本文:

刘赛靓, 周勇, 俞旻皓, 钟鸣. 右半结肠癌淋巴结清扫范围的临床研究进展[J]. 中华结直肠疾病电子杂志, 2020, 09(05): 507-511.

Sailiang Liu, Yong Zhou, Minhao Yu, Ming Zhong. The extent of lymph node excision in right hemicolectomy: a clinical review of the progression in lymphadenectomy[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(05): 507-511.

结直肠癌是一种常见的消化道恶性肿瘤,其中,右半结肠切除联合区域淋巴结清扫是右半结肠癌的标准术式。然而目前对右半结肠癌的淋巴结清扫范围尚未达成统一,欧美指南推荐的全结肠系膜切除(CME)合并中央血管结扎术(CVL),并未对淋巴结清扫范围有明确界定,而日本指南提出的D3手术风险较大,似乎有过度治疗之嫌。国内右半结肠癌手术推崇欧美的CME原则,而淋巴结清扫却效仿日本D2/D3的手术范围,至今尚未形成统一规范。本文将就右半结肠癌淋巴转移特点,和D2/D3淋巴结清扫的利弊做一综述。

Colorectal cancer is one of the most common malignant digestive tumors, of which colectomy combined with regional lymphadenectomy is the standard treatment. However, the extent of lymphadenectomy has not reached a consensus. The concept of complete mesocolic excision (CME) with central vascular ligation (CVL) proposed by European surgeons has not made a clear definition about the margin of lymph node excision, while D3 lymphadenectomy proposed by Japanese guideline proved to have more perioperative risks, which seems some kind of over-treatment. In our country, right hemicolectomy standard has not been established, surgeons perform right colectomy following the CME strategy and lymphadenectomy following D2/D3 excision standard. So, we reviewed the characteristics of lymph node metastasis of right colon cancer, and the advantages and disadvantages of D2/D3 lymphadenectomy.

图1 右半结肠癌淋巴结转移示意图[13]
图2 右半结肠癌D1、D2、D3手术范围示意图[14]。SMV:肠系膜上静脉,SMA:肠系膜上动脉
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