直肠癌手术中肠系膜下血管的离断部位——如何从现有的证据中作出选择

Location of inferior mesentery artery ligation in rectal cancer surgery:how to make decisions based on available evidence

直肠癌外科手术中于何处离断肠系膜下动脉、是否清扫中央组淋巴结, 至今尚存争议, 原因在于这方面的证据级别较低。现有的研究多为回顾性研究, 或小样本的RCT研究, 这些研究结果发现高位离断与低位离断之间, 在吻合口漏及术后短期并发症等发生情况方面没有区别。低位离断有助于术后生殖泌尿功能的恢复。直肠癌中央组淋巴结的转移率不高, 加之影响生存预后的混杂因素较多, 难以说明离断部位或中央组清扫对生存的获益。期待开展一些针对性强、设计良好、样本量大的随机对照研究来说明肠系膜下动脉离断部位和淋巴结清扫范围的相关问题。

There are still controversies as to the location of ligating the inferior mesenteric artery and the central lymph node dissection during rectal cancer surgery.The reason is that the level of evidence in this area is low.Existing studies are mostly retrospective,analyses or small-sample randomized controlled trials.These results showed no significant differences between high-ligation and low-ligation,in terms of anastomotic leakage and other short-term postoperative complications.Low-ligation seems better for the recovery of postoperative genitourinary function.Due to the low rate of central lymph node metastasis and many other confounding factors that affect the survival rate,it is difficult to conclude the survival benefits of ligation site or central node dissection.It is necessary to carry out some targeted,well-designed,large-scale randomized controlled trials to explain the related issues of inferior mesenteric artery ligation site and extent of central lymphadenectomy.