中国普外基础与临床杂志

中国普外基础与临床杂志

基于肠系膜解剖的结直肠癌外科手术治疗的研究进展

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目的 总结近年来结直肠癌外科手术治疗的变迁及进展,旨在为结直肠癌的外科治疗提供依据。 方法 复习近年来关于结直肠癌外科中全直肠系膜切除及全结肠系膜切除的相关文献并加以综述。 结果 全直肠系膜切除和全结肠系膜切除明显降低了结直肠癌患者的术后局部复发率,提高了无瘤生存率和总体生存率,明显改善了患者的预后,这可能得益于外科医生对肠系膜平面的精细解剖。此外,基于目前证据来看,结直肠癌全系膜切除术的安全性好、术后并发症少,有助于推动结直肠癌外科手术治疗的标准化。 结论 与传统手术相比,全直肠系膜切除和全结肠系膜切除可明显改善近期肿瘤学预后,但在远期肿瘤学预后上的优势尚需进一步研究。近年来腹腔镜、机器人外科、经自然腔道等新技术与肠系膜切除的结合为结直肠癌的外科治疗提供了新方向和新途径。

Objective To summarize the progress of surgical treatment of colorectal cancer in recent years from the anatomical features of the mesorectum, aiming to provide a new basis for surgical treatment of colorectal cancer. Methods The relevant literatures about total mesorectal excision and complete mesocolic excision in colorectal cancer surgery in recent years were reviewed. Results Total mesorectal excision and complete mesocolic excision significantly reduced the local recurrence rate of patients with colorectal cancer, improved the tumor-free survival rate and overall survival rate, and significantly improved the prognosis of patients, which may benefited from the surgeon’s detailed anatomy of mesenteric plane. In addition, based on current evidence, total mesorectal excision for colorectal cancer was safe and had fewer postoperative complications, which helped to promote the standardization of surgical treatment of colorectal cancer. Conclusions Total mesorectal excision and complete mesocolic excision can significantly improve histopathological prognosis compared with conventional surgery, but the advantages of long-term oncological prognosis need further study. In recent years, the combination of new techniques such as laparoscopy, robotic surgery and natural lumens, and mesenteric resection has provided new directions and new ways for surgical treatment of colorectal cancer.

关键词: 结肠癌; 全直肠系膜切除; 全结肠系膜切除; 综述;  

Key words: rectal cancer; colon cancer; total mesorectal excision; complete mesocolic excision; review

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