[Interpretation of technical operation standards for modified Bacon procedure (2026 edition)].

内容摘要

Technical Operation Standards for Modified Bacon Surgery (2026 Edition) (hereinafter referred to as the Standards) aims to systematically standardize the operative techniques of this procedure and promote its standardized implementation. The Standards are based on "one core principle, two techniques, three classifications, four necrosis types, and five nursing measures". This framework establishes specific technical operation standards for key aspects including indication and contraindication management, fixation and resection of the exteriorized bowel segment, tumor transection methods, classification and management of exteriorized bowel necrosis, and perioperative nursing measures. This article focuses on interpreting the five key features of the standards: (1) strict adherence to surgical indications and contraindications; (2) detailing single-stitch and multi-stitch fixation techniques for two-stage resection; (3) proposing for the first time three-type classification for tumor transection to guide preoperative decision-making; (4) introducing a four-type classification for necrosis of the exteriorized bowel segment, shifting management of this complication from empirical judgment to a classification-guided approach; and (5) systematically recommending five nursing measures-positional care, skin protection, postoperative analgesia, home care, and prevention of anastomotic stricture combined with pelvic floor muscle training-to create a comprehensive continum of postoperative care. This article also addresses the limitations of the Standards regarding technical standards for complex issues and levels of evidence, and interprets them in light of future research directions. It aims to provide a reference for the standardized implementation of modified Bacon surgery. 《改良Bacon手术技术操作标准（2026版）》（以下简称《操作标准》）旨在系统规范改良Bacon手术的操作技术，以推动该术式的标准化开展。《操作标准》以“一个中心、两项技术、三种肿瘤离断分型、四种坏死分型及五条护理措施”为基础，围绕适应证、禁忌证、外置肠管固定与切除、肿瘤离断方式、外置肠管坏死分型及处理和围手术期护理措施等关键环节制定具体的技术操作标准。本文重点解读《操作标准》的五大特色内容：（1）严格把握手术适应证与禁忌证；（2）一针法与多针法固定及二期切除技术；（3）首次提出了肿瘤离断三型分类，为术前决策提供依据；（4）提出外置肠管坏死的四型分类，使该并发症处理由经验判断走向分型管理；（5）系统推荐了体位护理、皮肤保护、术后镇痛、居家护理及吻合口狭窄预防与盆底肌训练五条护理措施，形成术后护理闭环。本文同时涉及《操作标准》在复杂问题技术标准与循证证据等级方面的局限性，并结合未来研究动向予以解读，以期为改良Bacon手术的规范开展提供参考。.