腹腔镜低位直肠癌经腹会阴联合切除并侧方淋巴结清扫术

Laparoscopic surgery for low rectal cancer with lateral lymph node dissection

手术采用5孔法,按日本学组提出的3间隙原则进行,TME手术完成第一间隙完整切除后,保护下腹神经丛及下腹神经,清扫其与髂总动脉、髂内动脉之间的第二间隙淋巴结,以及髂内外动脉间闭孔内的第三间隙淋巴脂肪组织。可视肿瘤部位、肿瘤浸润深度以及侧方淋巴结肿大情况,选择性行单侧或双侧的侧方淋巴结清扫。

Although long-term benefit of routine lateral lymph node dissection has not been proved by RCT, retrospective studies have shown its efficacy in lowering local recurrence and increasing survival rate in patients with lateral lymph node metastasis. The latest version of Japanese guidelines for the treatment of colorectal cancer still recommend lateral lymph node dissection, which is indicated when the lower border of the tumor is located distal to the peritoneal reflection and has invaded beyond the muscularis propria. Five ports were used for the laparoscopic procedure of lateral lymph node dissection. Three space dissections were performed, firstly total mesorectum excision, secondly dissection of lymph node between superior hypogastric plexus/hypogastric nerve and common/internal iliac arteries with preservation of autonerve, and lastly lymph node in the obturator formamen. One side or two sides lymph node dissection was performed according to the circumferential location of the tumor, the depth of tumor invasion and lateral lymph node status.