腹腔镜低位直肠癌盆腔侧方淋巴结清扫指征与策略

Indications and strategies of laparoscopic lateral pelvic lymph node dissection for low rectal cancer

低位直肠癌行直肠系膜切除术(ME)联合盆腔侧方淋巴结清扫术(lateral pelvic lymph node dissection,LPLND)存在争议,是否行预防性LPLND以及新辅助放化疗后治疗性LPLND均没有明确适应证。此外,盆腔侧方淋巴结清扫的术中及术后并发症值得关注,尤其是术中大出血以及术后泌尿生殖功能障碍的发生。因此,掌握低位直肠癌盆腔侧方淋巴结清扫的手术适应证,并制定手术策略,对于改善患者生存及预后,降低术中及术后并发症具有重要意义。

It is controversial to perform mesorectal excision(ME)combined with pelvic lateral lymph node dissection(LPLND)for low rectal cancer,and there are no definite indications for whether to perform prophylactic LPLND as well as therapeutic LPLND after neoadjuvant radiochemotherapy.In addition,intraoperative and postoperative complications of lateral pelvic lymph node dissection should be of concern,especially the occurrence of intraoperative hemorrhage and postoperative genitourinary dysfunction.Therefore,it is important to master the surgical indications for lateral pelvic lymph node dissection in low rectal cancer and to make a surgical strategy to improve the patient's survival and prognosis and to reduce intraoperative and postoperative complications.