直肠癌侧方清扫适应证及手术操作的要点  

Indications and operative points of lateral dissection for rectal cancer

作　　者：张豪 王自强[1] ZHANG Hao;WANG Ziqiang(Department of Gastrointestinal Surgery,West China Hospital,Sichuan University,Chengdu,610041 China)

机构地区：[1]四川大学华西医院胃肠外科,成都610041

出　　处：《临床外科杂志》2021年第5期495-498,共4页Journal of Clinical Surgery

基　　金：中华人民共和国科技部支撑项目;结直肠癌规范化诊疗临床队列研究(No.2017YFC0908204);四川大学华西医院135卓越临床研究孵化项目(No.2019HXFH031)。

摘　　要：侧方淋巴结转移(lateral lymph node metastasis, LLNM)是导致直肠癌术后侧方型复发,威胁病人预后的重要危险因素之一。研究表明,侧方淋巴结清扫(lateral lymph node dissection, LLND)是治疗直肠癌LLNM的重要手段。长期以来,LLND主要在日本,中国,韩国等东亚国家广泛开展。而近年来,欧美国家部分学者也在积极尝试LLND。LLND技术难度大,学习曲线长,容易发生大出血,盆丛神经损伤等并发症,并且术后泌尿生殖功能障碍发生率较高。目前为止,LLND尚缺少统一的入路方法及清扫标准。本文将从直肠癌LLND的适应证、手术操作的要点及术后并发症防治等方面进行综述。Lateral lymph node metastasis(LLNM) is one of the main risk factors for lateral pelvic recurrence and leading poor prognosis after total mesorectal excision for rectal cancer.Lateral lymph node dissection(LLND) has been proven as effective approach to control LLNM.For a long time, LLND was mainly performed in Eastern Asian including Japan, China, and South Korea.However, in recent years, LLND has been increasingly adopted in Western countries.LLND is technique demanding with longer learning curve.Besides, heavy bleeding and pelvic plexus injury is easy to occur during the procedure and would cause high incidence of urogenital dysfunction.Up to now, LLND still lacks standard surgical approach and scope.In this review, we would summarize the current evidence of LLND in terms of surgical indication, key steps, and postoperative complication.

关 键 词：直肠癌 侧方淋巴结转移 侧方淋巴结清扫 适应证 技术要点 并发症 

分 类 号：R735.37[医药卫生—肿瘤]