作者：中华医学会外科学分会结直肠外科学组，中国结直肠临床研究协作组

Authors: Chinese Society of Colorectal Surgery, Chinese Colorectal Research Consortium (CCRC)

摘要：

近20年来，随着腹腔镜技术的发展和应用以及完整结肠系膜理念的推广，右半结肠癌手术的技术和理念已经发生了较大的变化。近年来，世界范围内关于右半结肠手术的高质量临床研究开展和循证医学证据，为右半结肠癌手术的争议问题达成共识提供理论支撑。鉴于此，中华医学会外科学分会结直肠外科学组和中国结直肠临床研究协作组牵头，组织全国结直肠外科专家，就右半结肠癌手术的14项关键临床问题，结合我国医生及患者的偏好和干预措施的利弊，形成中国专家共识，以期规范右半结肠癌手术。共识主要包含以下三方面内容：①手术解剖院概括右半结肠癌手术系膜、筋膜、间隙、血管分支的结构和定义；并推荐肠系膜上动脉的左侧界作为完整结肠系膜切除手术的内侧界。②手术方式：推荐腹腔镜作为初始可切除右半结肠癌手术的首选手术方式。③手术原则：标准D2手术可作为右半结肠癌的常规手术方式。但术前影像评估和术中探查可疑区域淋巴结转移患者可考虑行完整结肠系膜切除术。除非考虑存在幽门下淋巴结转移，否则不建议常规行幽门下淋巴结清扫。此外，共识还对血管离断部位、肠管切除范围和消化道重建方式进行了推荐。

关键词： 结肠肿瘤，右半结肠；手术；全结肠系膜切除

Abstract：

In the past two decades, with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision, significant changes have occurred in the surgical treatment of right-sided colon cancer. The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium (CCRC) organized national experts in colorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy, taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures, with a view to standardizing the surgical treatment of right colon cancer. The consensus recommendations were focused on three main aspects: ①surgical anatomy: the key structures and its definitions related to the mesentery and vascular anatomy were clarified. It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision; ②surgical technique: laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer; ③surgical principles: D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer. Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis. Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis. Additionally, consensus recommendations were made regarding the location of vascular ligation, the extent of bowel resection, and anastomosis techniques.

Key Words:  Colonic neoplasms, right-sided colon; Surgery; Complete mesocolic excision

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