检索历史 清除

侧方淋巴结转移是低位直肠癌的重要转移途径,也是直肠癌患者预后不良的重要因素之一.众多循证医学证据表明:围手术期放化疗并不能彻底杀灭转移的侧方淋巴结;对放化疗后仍然残留的侧方转移淋巴结进行清除,可以显著减少局部复发,改善预后,是这部分患者实现无瘤生存的唯一 途径.然而,直肠侧方区域空间狭小,解剖结构复杂,血管神经密集,使侧方淋巴结清扫面临手术时间长、术中出血量多、标本难以整块切除以及术后并发症发生率高等问题,限制了侧方淋巴结清扫在临床的普及和推广.随着筋膜解剖研究的深入,直肠周围筋膜结构逐渐为临床ManBetX万博官网地址下载 所熟悉.对直肠侧方空间进行分区,以筋膜为导向行侧方淋巴结清扫,可以建立明确的手术操作平面和清扫范围边界,避免清扫范围的不足和过度,有助于将侧方淋巴结清扫这一术式标准化;沿筋膜结构进行游离,避免进入淋巴组织,可以预防转移癌细胞的扩散;同时也有助于减少渗出和出血,对盆腔自主神经予以更好的保护.筋膜导向的侧方清扫更加符合现代解剖学理念,有更好的肿瘤根治和功能保护效果,同时有助于侧方清扫手术的普及推广和质量控制.

Lateral lymph node metastasis is an important pathway for metastasis of low rectal cancer, which is also one of the most important risk factors for bad prognosis. Numerous evidences from evidence?based medicine demonstrate that both preoperative and postoperative chemoradiotherapy cannot eradicate lateral lymph node metastasis. Since selective resection of lateral lymph nodes with tumor residue after chemoradiotherapy can significantly decrease local recurrence rate and improve cancer prognosis, it is the only treatment modality for these patients to achieve disease?free survival. However, because of the narrow space, complicated anatomy and dense vessels and nerves of lateral area around rectum, lateral lymph node dissection (LLND) has many problems, such as long operation time, excessive intraoperative bleeding, piecemeal resection of lymphoid issue and high morbidity of postoperative complications, which restrict the clinical promotion of LLND. With the development in the study of fascia anatomy, surgeons are gradually familiarized with the perirectal fascia. Partitioning rectal lateral space and performing LLND based on fascia orientation can provide clear surgical plane and dissection boundary. Furthermore, it can avoid insufficient and excessive resection. Moreover, resecting tissue along fascia structure can avoid entering lymph tissue and prevent dissemination of malignant cells. Meanwhile, it can reduce exudation and bleeding, and present better pelvic autonomic nerve preservation. LLND based on fascia orientation is more in line with the concept of modern anatomy, more efficient both in tumor radical resection and function protection, and contributes to the promotion and quality control of LLND.