腹腔镜直肠癌侧方淋巴结清扫术中淋巴结定位技术要点  

Key tips to ensure localization of the suspicious nodes in patients undergoing laparoscopic lateral lymph node dissection

作　　者：王自强[1] 黄昊 WANG Zi-qiang;HUANG Hao(Colorectal Cancer Center,West China Hspital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院结直肠肿瘤中心,四川成都610041

出　　处：《中国实用外科杂志》2023年第10期1125-1128,共4页Chinese Journal of Practical Surgery

基　　金：四川省科技厅科技支撑计划重点研发项目(No.2021YFS0025)。

摘　　要：侧方淋巴结清扫是治疗直肠癌侧方淋巴结转移的重要手段,但术后仍有较高的局部复发率,这与未联合放化疗、盆腔侧壁解剖结构的复杂性以及外科手术的不彻底性相关,术前应采用影像动态观察、盆腔血管三维重建等方法熟悉病人的盆腔解剖结构和需切除血管范围,术中采用规范化的筋膜导向淋巴结清扫、血管辅助定位淋巴结、合理切除血管分支、吲哚菁绿示踪等技术,以提高选择性侧方淋巴结清扫的彻底性,降低局部复发率。Lateral lymph node dissection has become the treatment of choice for patients with suspicious lateral lymph node metastasis.However,lateral lymph node dissection has been associated with a considerable rate of lateral pelvic recurrence,generally attributed to avoidance of chemoradiotherapy,anatomical complexity of the pelvis and suboptimal surgery.Surgeons dedicated to lateral lymph node dissection should familiarize themself with the pelvic anatomy of each patient and the location of lymph nodes by studying CT images with radiologists or using a three-dimensional printed model of pelvic vessels and plan for the extent of vascular division accordingly.Intraoperatively,a standardized procedure of fascia-oriented lateral lymph node dissection,the proper extent of vascular excision dependent on localization of suspicious lymph nodes,and indocyanine green fluorescence imaging guidance should be implemented to ensure complete excision of all suspicious lateral lymph nodes and minimize the risk of local recurrence.

关 键 词：直肠癌 侧方淋巴结清扫 腹腔镜 淋巴结 定位 

分 类 号：R6[医药卫生—外科学]