直肠癌和乙状结肠癌根治术中肠系膜下动脉根部淋巴结清扫的相关热点问题及研究进展

Related questions and research improvements of apical lymph node dissection in rectal and sigmoid cancer surgery

对于直肠癌和乙状结肠癌(简称直乙结肠癌)手术患者,在遵循全直肠系膜切除原则基础上,是否需要完成D3淋巴结清扫一直是讨论热点之一。作为D3清扫的关键点,肠系膜下动脉根部淋巴结具有较重要的临床意义。该文基于现有研究,对直乙结肠癌根治术中肠系膜下动脉淋巴结清扫的若干问题进行探讨,包括肠系膜下动脉淋巴结清扫的术式,肠系膜下动脉清扫中血管结扎位置的选择,病理阳性肠系膜下动脉根部淋巴结的临床意义等,并结合作者经验介绍最新研究进展。随着精准医学及循证医学的发展,清扫IMA根部淋巴结及术后精确评估IMA根部淋巴结的病理学结果具有重要的临床价值。临床决策需要更多真实、高级别临床研究提供证据支持。

The necessity of D3 dissection is one of the most controversial research spot in rectal and sigmoid cancer surgery.As the key point of D3 dissection,the apical lymph node by the root of inferior mesenteric artery has important clinical significance.In this article,we discussed about several hottest questions about apical lymph node dissection,including surgery characteristics,high or low ligation,and clinical significance of metastatic apical lymph nodes.We also introduced the latest studies regarding to these questions.With the improvement of precision medicine and evidence-based medicine,it is becoming more valuable to make better evaluation of the pathological status and make better decision on whether or not to dissect the inferior mesenteric artery root lymph node.More high-quality clinical research is still required to get better knowledge of it.