直肠癌根治术中解剖学争议探讨

Anatomical controversies involved in radical resection of rectal cancer

全直肠系膜切除的理念为直肠癌的根治手术提供了可以遵循的质量控制标准,但是尚有部分解剖学问题存在争议。腹腔镜直肠癌根治术虽然具有更好的手术视野、更佳的神经功能保护、更大的操作空间,但若术者对解剖结构或解剖变异认知不足,可能会出现术中不可控制的出血、术后排尿排粪功能障碍等副损伤。笔者通过对国内外研究的分析总结,并结合临床经验,针对直肠癌根治术涉及的几个解剖争议问题,包括肠系膜下血管解剖及变异、肠系膜下动脉离断平面的争议、第253组淋巴结清扫的争议、直肠中动脉的解剖学变异及直肠癌侧方淋巴结清扫的解剖学争议等进行阐述,旨在为临床外科医师提供一个更好的认知过程。

The concept of total mesorectal resection provides a quality control standard that can be followed for radical resection of rectal cancer,but some anatomical problems are still controversial.Compared with traditional open surgery,laparoscopic radical rectal surgery has better surgical vision,better neurological protection,better operating space.However,if the surgeon has insufficient understanding of the anatomy,collateral damage may occur,such as uncontrollable bleeding during the operation,postoperative urination and defecation dysfunction and so on.Based on the interpretation of the researches at home and abroad,combined with the clinical experience,we elucidate some associated issues,including anatomic variation of inferior mesenteric vessels,the controversy of inferior mesenteric artery ligation plane,the controversy of lymph node dissection in No.253,the anatomical variation of middle rectal artery,and the anatomical controversy of lateral lymph node dissection in rectal cancer,in order to provide better cognitive process for the clinical front⁃line surgeons.