Chang Y, Liu H L, Lin M B
Department of General Surgery, Yangpu Hospital; Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai 200090, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2022 Apr 25;25(4):315-320. doi: 10.3760/cma.j.cn441530-20220107-00016.
As a treatment of rectal cancer, lateral lymph node dissection (LLND) is still a controversial issue. The argument against LLND is that the procedure is complicated, and consequently results in a high incidence of postoperative urogenital dysfunction. The surgical modality from fascia to space is adopted by lateral lymph node dissection in "two spaces". This operation has significant advantages of clear location of nerves and blood vessels and simplified surgical procedures, so the surgical procedure can be repeated and modulated. The fascia propria of the rectum, urogenital fascia, vesicohypogastric fascia and parietal fascia constitute the dissection plane for lateral lymph node dissection.Two spaces refer to Latzko's pararectal space and paravesical space. During the establishment of fascia plane, the dissection of external iliac lymph node (No.293), commoniliac lymph node (No.273) and abdominal aortic bifurcation lymph node (No.280) can be performed. While in the "space" dissection, internal iliac lymph node (No.263), obturator lymph node (No.283), lateral sacral lymph node (No.260) and median sacral lymph node (No.270) can be removed. LD2 or LD3 lateral lymph node dissection prescribed by the Japanese Society of Colorectal Cancer can be completed according to the needs of the disease. This article describes the anatomical basis and standardized surgical procedures.
作为直肠癌的一种治疗方法,侧方淋巴结清扫术(LLND)仍然是一个有争议的问题。反对侧方淋巴结清扫术的观点是该手术复杂,因此导致术后泌尿生殖功能障碍的发生率很高。“两间隙”侧方淋巴结清扫术采用从筋膜到间隙的手术方式。该手术具有神经和血管定位清晰、手术步骤简化等显著优点,因此手术过程可以重复和调整。直肠固有筋膜、泌尿生殖筋膜、膀胱腹下筋膜和壁层筋膜构成了侧方淋巴结清扫术的解剖平面。两间隙是指拉茨科直肠旁间隙和膀胱旁间隙。在建立筋膜平面的过程中,可以进行髂外淋巴结(第293组)、髂总淋巴结(第273组)和腹主动脉分叉处淋巴结(第280组)的清扫。而在“间隙”清扫过程中,可以切除髂内淋巴结(第263组)、闭孔淋巴结(第283组)、骶外侧淋巴结(第260组)和骶中淋巴结(第270组)。根据疾病的需要,可以完成日本结直肠癌学会规定的LD2或LD3侧方淋巴结清扫术。本文描述了解剖学基础和标准化手术步骤。