中低位直肠癌主淋巴结转移和清扫的争议与探讨

Controversy and discussion on primary lymph node metastasis and dissection of middle and low rectal cancer

中低位直肠癌是常见的结直肠肿瘤,淋巴结转移尤其是主淋巴结转移是影响其预后的重要因素。肠系膜下动脉根部淋巴结和侧方淋巴结是该部位肿瘤不同引流方向的主淋巴结。笔者结合文献和临床经验,对上述2条淋巴引流途径的特点、主淋巴结区域界定、转移的临床意义、清扫范围及手术方式进行深入探讨,寻找争议焦点,倡导共同关注相关问题的临床和基础研究,作出更合适的临床决策,进一步提高中低位直肠癌的疗效。

Middle and low rectal cancer is one of the most common colorectal cancers.The lymph node metastasis,especially primary lymph node metastasis,is an important factor affecting prognosis of middle and low rectal cancer.Inferior mesenteric artery root lymph nodes and lateral lymph nodes are the primary lymph nodes of middle and low rectal cancer in different drainage direction.Based on literatures and clinical experiences,the author discusses the characteristics,main areas,clinical significance of metastasis,range of dissection and operation methods of the above two lymphatic drainage way,to find out the focus of controversy.The author advocates to focus on the clinical and basic researches of related problems and make more appropriate clinical decisions to improve the curative effect of middle and low rectal cancer.