直肠癌侧方淋巴结清扫中国临床开展的现状

The clinical status of lateral lymph node dissection for rectal cancer in China

尽管目前东西方对于直肠癌侧方淋巴结清扫仍存争议,但中国学术界依据现有的循证医学证据制定了符合中国国情的侧方淋巴结清扫相关共识、指南和规范。相较于日本,国内侧方淋巴结清扫指征把握更加严格,仅当有明确影像学证据疑诊存在侧方淋巴结转移时,才会选择性进行清扫,常规清扫区域也仅限于髂内和闭孔周围。基于全面了解盆腔解剖结构的前提下,以筋膜为导向的两间隙清扫现已成为中国侧方淋巴结清扫的主流方案,该术式在明确清扫边界、保护神经功能、彻底清除侧方淋巴结等方面具有明显优势。未来随着更多的高质量侧方淋巴结清扫研究的进行,将会有更多的证据来规范直肠癌侧方淋巴结清扫的临床应用。

Although there is still controversy between the East and the West on lateral lymph node dissection of rectal cancer,Chinese academia has formulated the consensus,guidelines,and norms of lateral lymph node dissection in line with China's national conditions based on the existing evidence-based medicine.Compared with Japan,the lateral lymph node dissection indication in China is more strict,and only when there is clear imaging evidence suspected of lateral metastatic lymph nodes will selective dissection be carried out.The routine dissection area is also limited to the internal ilium and around the obturator.Based on a comprehensive understanding of the anatomical structure of the pelvis,fascia-guided clearance of the two spaces has become the mainstream scheme of lateral lymph node dissection in China.This operation has obvious advantages in clear lymph node dissection boundary,protection of nerve function,complete removal of lateral lymph nodes,and so on.In the future,with the progress of more high-quality lateral lymph node dissection studies,there will be more evidence to regulate the clinical application of lateral lymph node dissection for rectal cancer.