Merkel S, Weber K, Perrakis A, Göhl J, Hohenberger W
Chirurgische Klinik, Universitätsklinikum Erlangen, Deutschland.
Chirurg. 2010 Feb;81(2):117-22; 124-26. doi: 10.1007/s00104-009-1814-9.
Lymph node dissection is almost always indicated in the treatment of advanced colorectal carcinoma with curative intent. Investigation of at least 12 regional lymph nodes is required for adequate staging. The extent and quality of lymph node dissection influence the long-term prognosis, especially locoregional recurrences and long-term survival. The extent of lymphadenectomy depends on the tumour site and the pattern of potential lymphatic spread following the course of the blood vessels supplying the tumour. Important principles are central ligation of the supplying arteries and draining veins right at their roots, preservation of autonomous nerves at the trunk of the superior mesenteric artery and the aorta and preservation of the integrity of the mesocolon or mesorectum. The number of regional lymph nodes examined as well as the number of lymph nodes with metastases influence the prognosis. Systematic lymph node dissection is also recommended for carcinomas of the small bowel and in most neuroendocrine tumours or carcinomas but is not required for gastro-intestinal stromal tumours.
对于有治愈意图的晚期结直肠癌治疗，几乎总是需要进行淋巴结清扫。为了进行充分的分期，至少需要检查12个区域淋巴结。淋巴结清扫的范围和质量会影响长期预后，尤其是局部区域复发和长期生存。淋巴结切除术的范围取决于肿瘤部位以及肿瘤供血血管走行后的潜在淋巴扩散模式。重要原则包括在供应动脉和引流静脉的根部进行中央结扎，在肠系膜上动脉主干和主动脉处保留自主神经，以及保留结肠系膜或直肠系膜的完整性。检查的区域淋巴结数量以及有转移的淋巴结数量会影响预后。对于小肠癌以及大多数神经内分泌肿瘤或癌，也建议进行系统性淋巴结清扫，但胃肠道间质瘤不需要。
