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中华结直肠疾病电子杂志

中华结直肠疾病电子杂志 ›› 2020, Vol. 09 ›› Issue (03) : 283 -287. doi: 10.3877/cma.j.issn.2095-3224.2020.03.013

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综述

进展期中低位直肠癌的个体化侧方淋巴结清扫策略研究进展
杜瑞1, 汤东2, 王道荣2,†()   
  1. 1. 116044　大连医科大学研究生院
    2. 225001　扬州大学临床医学院，江苏省苏北人民医院胃肠外科，扬州大学-扬州市普通外科研究所
  • 收稿日期:2019-10-18 出版日期:2020-06-25
  • 通信作者: 王道荣
  • 基金资助:
    江苏省重点病种规范化诊疗项目(No.BE2015664)

Research progress of individualized lateral lymph node dissection strategy for advanced low-grade rectal cancer

Rui Du1, Dong Tang2, Daorong Wang2,†()   

  1. 1. Graduate School, Dalian Medical University, Dalian 116044, China
    2. Department of Gastrointestinal Surgery, Subei People′s Hospital of Jiangsu Province, Yangzhou University Clinical Medical College, Yangzhou University-Yangzhou Institute of General Surgery, Yangzhou 225001, China
  • Received:2019-10-18 Published:2020-06-25
  • Corresponding author: Daorong Wang
  • About author:
    Corresponding author: Wang Daorong, Email:
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杜瑞, 汤东, 王道荣. 进展期中低位直肠癌的个体化侧方淋巴结清扫策略研究进展[J]. 中华结直肠疾病电子杂志, 2020, 09(03): 283-287.

Rui Du, Dong Tang, Daorong Wang. Research progress of individualized lateral lymph node dissection strategy for advanced low-grade rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2020, 09(03): 283-287.

中低位直肠的淋巴引流主要向上和外侧方向，已证实中低位直肠癌存在侧方淋巴结转移，但目前侧方淋巴结清扫存在争议，西方国家不常规进行侧方淋巴结清扫（LLND），更注重新辅助治疗（nCRT），主要原因是西方学者认为LLND存在不确定的肿瘤学效果和并发症高发生率。然而，最新证据表明，对部分进展期中低位直肠癌患者，新辅助治疗联合全直肠系膜切除术（TME）可能达不到最佳治疗效果。本文旨在阐述中低位直肠癌选择性侧方淋巴结清扫的现状及进展，探索中低位直肠癌进一步治疗的趋势和方向——选择性和个体化的侧方淋巴结清扫术。

关键词: 直肠肿瘤, 全直肠系膜切除术, 侧方淋巴结清扫术, 新辅助治疗

Lymphatic drainage in the middle and lower rectum is mainly in the superior and lateral directions. Lateral lymph node metastasis has been confirmed in the middle and lower rectal cancer. However, the current lateral lymph node dissection is controversial. Lateral lymph node dissection (LLND) is not routinely performed in western countries. More emphasis is placed on neoadjuvant chemoradiotherapy (nCRT). The main reason is that western scholars believe that LLND has uncertain oncological effects and high complication rates. However, recent evidence suggests that neoadjuvant therapy combined with total mesorectal excision (TME) may not be sufficient in patients with low-grade rectal cancer in some advanced stages. This article aims to describe the current status and progress of selective lateral lymph node dissection in low- and moderate-grade rectal cancer, and to explore the trend and direction of further treatment of middle and low rectal cancer: selective and individualized lateral lymph node dissection.

Key words: Rectal neoplasms, Total mesorectal excision, Lateral lymph node dissection, Neoadjuvant therapy
图1 直肠周围的三个间隙[7]
图2 直肠周围的区域淋巴结[12]
图3 侧方淋巴结清扫中的三个分区[38]。3A：骨盆外侧解剖结构；3B：侧方淋巴结清扫的三个分区（1：下腹神经至盆腔丛；2：髂内血管主干及膀胱、前列腺和神经血管束的几个分支；3：内闭孔肌）
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