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中华结直肠疾病电子杂志 ›› 2026, Vol. 15 ›› Issue (02) : 115 -121. doi: 10.3877/cma.j.issn.2095-3224.2026.02.003

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结直肠癌手术切除范围的理论依据
王利明, 马浩越, 余永刚, 陈瑛罡()   
  1. 518116 深圳,国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院深圳医院胃肠外科
  • 收稿日期:2025-09-25 出版日期:2026-04-25
  • 通信作者: 陈瑛罡
  • 基金资助:
    深圳市高水平医院建设专项经费

Theoretical basis for the extent of surgical resection in colorectal cancer

Liming Wang, Haoyue Ma, Yonggang Yu, Yinggang Chen()   

  1. Department of Gastrointestinal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen 518116, China
  • Received:2025-09-25 Published:2026-04-25
  • Corresponding author: Yinggang Chen
引用本文:

王利明, 马浩越, 余永刚, 陈瑛罡. 结直肠癌手术切除范围的理论依据[J/OL]. 中华结直肠疾病电子杂志, 2026, 15(02): 115-121.

Liming Wang, Haoyue Ma, Yonggang Yu, Yinggang Chen. Theoretical basis for the extent of surgical resection in colorectal cancer[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2026, 15(02): 115-121.

规范的淋巴结清扫与阴性切缘是结直肠癌根治术获得良好预后的基石。然而,对于肠管切除的合理范围,尤其是直肠癌的远切缘长度,国际上不同指南(如欧美与日本)存在差异,直接影响手术方式与功能保留决策。本文旨在系统综述结肠癌及不同部位直肠癌肠管切除范围的理论依据。通过分析比较欧美全系膜切除理念与日本基于淋巴结转移模式的精确测量数据,本文重点探讨了结肠癌(近、远切缘各10 cm)、直肠乙状部与高位直肠癌(远切缘3 cm)、低位直肠癌(远切缘2 cm)以及特殊情形(如新辅助治疗后、低分化类型)的切除原则。文中汇总了多项关键研究数据,为外科医生在临床实践中制定个体化、精准化的手术方案提供了循证参考。

Standardized lymph node dissection and negative surgical margins are fundamental to achieving optimal outcomes in radical resection for colorectal cancer. However, discrepancies exist among international guidelines (e.g., European/American vs. Japanese) regarding the optimal extent of bowel resection, particularly the length of the distal margin in rectal cancer, which directly influences surgical approach and decisions on functional preservation. This article aims to systematically review the theoretical basis for the extent of intestinal resection in colon cancer and rectal cancer at different sites. By analyzing and comparing the Western concept of total mesenteric excision with Japanese data on precise measurements based on lymph node metastasis patterns, this paper focuses on the principles for resection margins: 10 cm for both proximal and distal margins in colon cancer, 3 cm for rectosigmoid and high rectal cancer, 2 cm for low rectal cancer, and special considerations (e.g., post-neoadjuvant therapy, poorly differentiated types). Key research data are summarized to provide evidence-based references for surgeons to develop individualized and precise surgical strategies in clinical practice.

表1 结肠癌淋巴结转移率(%)
图1 临床分期0~Ⅲ期的大肠癌治疗方针(根据日本大肠癌治疗指南以及最近的论文改订)[1]
图2 结肠癌肠管旁淋巴结转移分布(作者团队绘制)
图3 直肠癌手术系膜切除范围。3A:全直肠系膜切除(TME);3B:肿瘤特异性系膜切除(作者团队绘制)
表2 直肠癌的肛门侧进展相关报告
图4 直肠肛门侧肠管及系膜切除范围。4A:肿瘤下缘位于腹膜返折以上;4B:肿瘤下缘位于腹膜返折以下(作者团队绘制)
表3 结直肠癌切除范围推荐
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