侧方淋巴结清扫术在低位直肠癌根治术中的可行性探讨(附20例报道)  

Re-evaluation the feasibility of lateral lymph node dissection in radical resection of low rectal cancer:report of 20 cases

作　　者：邵鹏 司呈帅 曹月鹏 周欣[1] 章旭 李东正[1] Shao Peng;Si Chengshuai;Cao Yuepeng;Zhou Xin;Zhang Xu;Li Dongzheng(Department of General Surgery,the Affiliated Cancer Hospital of Nanjing Medical University&Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research,Nanjing 210000,China)

机构地区：[1]南京医科大学附属肿瘤医院、江苏省肿瘤医院、江苏省肿瘤防治研究所普通外科,210000

出　　处：《中华结直肠疾病电子杂志》2023年第2期167-171,共5页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨侧方淋巴结清扫在低位直肠癌手术中的意义以及结合本中心实际探究术前影像学数据用于评估侧方淋巴结是否转移的准确性。方法对南京医科大学附属肿瘤医院术前影像学检查高度怀疑侧方淋巴结有转移的患者行侧方淋巴结清扫术,并对术后病理为阴性可能的原因进行分析。结果侧方淋巴结无转移,瘤旁及系膜淋巴结转移率为70%,其中高分化腺癌淋巴结转移率为30%,中低分化腺癌淋巴结转移率为85.7%。结论术前仅凭影像学评估淋巴结的大小及形态来诊断侧方淋巴结是否转移进而指导手术清扫相对困难,其准确性有待商榷;侧方淋巴结转移的发生率很低,低位直肠癌患者实施侧方淋巴结清扫术应当慎之又慎,术前除对患者进行全面的影像学评估外,还应充分了解患者的既往病史等情况,必要时需进行多学科会诊(MDT)决定手术方案。Objective To study the significance of lateral lymph node dissection in low rectal cancer surgery and explore the accuracy of preoperative imaging data used to evaluate whether lateral lymph node metastasis combined with the practice of Jiangsu Cancer Hospital.Methods The possible reasons for the negative pathology after lateral lymph node dissection were analyzed for the patients with lateral lymph node metastasis highly suspected by preoperative imaging examination in our hospital.Results There was no metastasis in lateral lymph nodes,and the metastasis rate in mesenteric lymph nodes was 70%.The metastasis rate of well-differentiated adenocarcinoma was 30%,and the metastasis rate of moderately poorly differentiated was 85.7%.Conclusion It is difficult to diagnose lateral lymph node metastasis and guide surgical dissection only by imaging evaluation of lymph node size and morphology before surgery,and its accuracy is questionable.The incidence of lateral lymph node metastasis is very low,lateral lymph node dissection should be performed with great caution in patients with low rectal cancer.In addition to a comprehensive imaging evaluation,previous medical history and other conditions of patients should be full considered before surgery.MDT could be conducted to aid surgical decision-making if necessary.

关 键 词：直肠肿瘤 全直肠系膜切除术 侧方淋巴结清扫 

分 类 号：R735.37[医药卫生—肿瘤]