右半结肠癌CME/D3根治术淋巴结清扫内侧界的争议
Controversy over the medial border of lymph node dissection during CME/D3 surgery of right colon cancer
Received date: 2023-05-17
Online published: 2023-08-18
根治性外科手术是结肠癌的最主要治疗措施。完整系膜切除术（complete mesentery excision, CME）/D3淋巴结清扫术的发展应用，推动结肠癌手术技术的规范化、标准化进程。右半结肠癌手术相对复杂，是当前研究的热点之一。涉及的问题包括淋巴结清扫范围、肠管切除范围、肠管重建方式等。右半结肠癌淋巴结清扫的内侧界是当前争议的焦点之一。肠系膜上静脉左侧通常被认为是右半结肠癌CME/D3清扫的内侧界。然而，随着相关研究的深入开展，部分学者认为应当以肠系膜上动脉左侧为清扫的内侧界。该观点更符合CME的原则，且能做到彻底的淋巴结清扫，但其临床意义仍需深入研究论证。本文针对右半结肠癌淋巴结清扫内侧界的选择展开讨论，希望为临床实践提供参考。
孙跃明, 张冬生 . 右半结肠癌CME/D3根治术淋巴结清扫内侧界的争议[J]. 外科理论与实践, 2023 , 28(03) : 202 -207 . DOI: 10.16139/j.1007-9610.2023.03.005
Radical surgery is the most important treatment for colon cancer. The development and application of complete mesentery excision (CME)/D3 lymph node dissection has promoted the standardization of surgical techniques for colon cancer. Right colon cancer surgery is relatively complicated, and is a research hotspot currently. The issues involved the range of lymph node dissection, the range of bowel resection, and the method of bowel reconstruction. The medial border of lymph node dissection for right colon cancer is one of the controversies. The left side of the superior mesenteric vein is generally considered to be the medial border of CME/D3 dissection in right colon cancer surgery. However, with the in-depth development of related research, some scholars believed that the left side of the superior mesenteric artery should be used as the medial border for lymph node dissection. This approach is more consistent with the principle of CME, and can achieve complete lymph node dissection. However, its clinical significance still needs to be evaluated with further research. This article discusses the selection of medial border of lymph node dissection for right colon cancer, hoping to provide reference for clinical practice.
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