大肠癌的治疗课件

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1、大肠癌的治疗Thetreatmentofcolorectalcarcinoma徐为徐州医学院临床学院外科教研室大肠癌的治疗原则手术治疗为主其他治疗为辅的综合治疗结肠癌根治性手术Theradicaldissectionofcoloniccarcinoma切除范围癌肿所在肠袢相关肠系膜区域淋巴结CaCa癌肿所在肠袢相关肠系膜适应证盲肠癌升结肠癌结肠肝曲癌切除范围横结肠右半升结肠盲肠回肠末段右半结肠切除术Theresectionofrightsidecolon用于横结肠癌切除范围肝曲~脾曲结肠相应系膜胃结肠

2、韧带的相应淋巴结组横结肠癌切除术Theresectionoftransversecolon结肠脾曲癌降结肠癌切除范围横结肠左半降结肠部分或全部乙状结肠左半结肠切除术Resectionofliftsidecolon适应证切除范围切除范围取决于乙状结肠长短和肿瘤的部位降结肠+乙状结肠乙状结肠+部分直肠+部分降结肠用于乙状结肠癌乙状结肠癌根治切除术Theradicaldissectionofsigmoidcancer直肠癌局部切除术Localresectionofrectalcancer适用证早期瘤体较小局

3、限于粘膜或粘膜下层分化程度高手术方式经肛局部切除术骶后经路局部切除术LocalProceduresCandidates:Tumourslessthan10cmfromthedentatelineThelesionsshouldbemobileondigitalexamination,lessthan5cmindiameterandoffavourabledifferentiationLocalresectionshouldbelimitedtoT1andT2tumours.Notwithlymphnodem

4、etastasis腹会阴联合直肠癌根治术（Miles手术）适用范围：腹膜返折以下直肠癌乙状结肠远段全部直肠肠系膜下动脉及其区域淋巴结全直肠系膜肛提肌坐骨直肠窝内脂肪肛管肛门周围约5cm直径皮肤皮下组织全部肛门括约肌切除范围MilesprocedureRectalcancerlocatedabdominalretatinglevel，localintestinalwallenhanced，wecanseetheobviousshrinkingtumorinpostoperativesampleHepaticm

5、etastasiscancerresectionGreyishwhitearea:cancercancerOringinalcancer＋hepaticmetastasisresectionMetastasishepaticcancerColiccancer(oringinalcancer)Resectionafterofthetuomrminim-izedbyinterventionaltreatmentTotalmesorectumexcisionThemesorectumconsistsoffattyt

6、issuesurroundingtherectumandcontainsthelymphaticsdepositsoftumourwithinthemesorectumupto3cmdistaltothemaintumour.Totalmesorectalexcisionhasreducedlocalrecurrence(lessthan10%)经腹直肠癌切除术（Dixon手术）适用于距齿线5厘米以上的直肠癌原则远切端距癌肿下缘3厘米以上确保根治性切除缺点:根治的彻底性差术后近期排便控制性差优点：去瘤保肛

7、提高生活质量AlthoughthemanagementofcolonicmalignancieshasnotalteredgreatlyinrecentyearsthisisnottrueofrectalcancerDistalMicrometastasisofTheRectalcancerTheabnormalretrogradespreadofrectalcanceris’tcommononlythatthelymphaticvesselsofalongtheinferiormesentericarter

8、yareblockedDistalintramuralspreadseldomexceedsafewmillimetresanddistallymphaticspreadisrare超低位直肠癌的概念低位直肠癌：5<肿瘤下缘距肛缘<8cm超低位直肠癌：肿瘤下缘距肛缘5cm超低位直肠癌手术仍有较大争议焦点：何种患者适合保留肛门超低位直肠癌保肛手术必备的条件切除肿瘤的彻底性与APR相同（主要指局部复发