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直肠癌的侧方淋巴结清扫的范围、指征及疗效,不同国家、不同学派的医生的观点存在一定差异。目前认为侧方清扫主要适用于中低位、病理为低分化或T3～4的直肠癌病人,术前可应用放射性核素显像、腔内超声或PET-CT等评估侧方淋巴结情况。侧方清扫对外科技术要求很高,术中应注意在髂内血管和盆壁及闭孔筋膜之间进行分离,直至暴露闭孔神经,清扫淋巴结总数至少应在10枚以上。目前侧方清扫可以降低肿瘤复发率已得到肯定,但侧方淋巴结清扫已达第3、4站,其必要性国际上仍存在争论。笔者认为侧方淋巴结清扫仍有生命力及存在价值,TME基础上改良清扫或选择性侧方淋巴结清扫。腹腔镜下的TME及侧方清扫等均是直肠癌手术今后若干的方向之一。
The scope, indications and curative effects of lateral lymph node dissection in rectal cancer are different from those of doctors in different countries and different schools. Currently considered lateral cleaning is mainly applied to low-grade, pathologically poorly differentiated or T3 ~ 4 patients with rectal cancer, radionuclide imaging can be applied before surgery, endoscopic ultrasound or PET-CT assessment of lateral lymph nodes. Side of the surgical technique is very demanding, surgery should pay attention to the iliac vessels and pelvic wall and closed fascia between the separation until the exposed obturator nerve, the total number of lymph nodes should be cleaned in at least 10 or more. At present, lateral resection can reduce the tumor recurrence rate has been affirmed, but the lateral lymph node dissection has reached the 3rd and 4th stations, the necessity of the international debate. The author believes that lateral lymph node dissection still has vitality and existence value, TME based on the improvement of cleaning or selective lateral lymph node dissection. Laparoscopic TME and lateral scans are some of the future direction of rectal cancer surgery.