中国实用外科杂志

中国实用外科杂志

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左半结肠癌行No.223、No.253淋巴结清扫意义及争议

王    权，佟伟华，张加鑫   

  1. 吉林大学第一医院胃结直肠外科，吉林长春130021
  • 出版日期:2020-03-01 发布日期:2020-03-18

  • Online:2020-03-01 Published:2020-03-18

摘要： 淋巴结转移是结直肠癌的主要转移方式，NCCN、日本大肠癌研究会（JSCCR）和我国结直肠癌诊疗相关规范都规定了结肠癌根治术需要行区域淋巴结清扫，No.223、No.253淋巴结属于左半结肠癌的区域淋巴结。结肠脾曲癌由结肠中动脉左支和左结肠动脉双重供血，推荐行No.223、No.253淋巴结清扫，降结肠癌和乙状结肠癌主要由肠系膜下动脉供血，只须行No.253淋巴结清扫。目前，部分研究认为血管低位结扎（血管根部淋巴结清扫）与血管高位结扎对于淋巴结清扫数量及肿瘤学效果一致，部分研究提示血管高位结扎可能影响肠管血供，增加吻合口漏的发生。因此，推荐清扫No.223、No.253淋巴结时可以保留结肠中动脉和肠系膜下动脉。由于左半结肠癌发病率较低，目前缺乏有说服力的证据，期待临床进行高级别循证医学研究进一步明确淋巴结清扫范围。

关键词: 左半结肠癌, 淋巴结清扫, No.223淋巴结, No.253淋巴结

Abstract: No.223, No.253 lymph node dissection for left colon cancer: Significance, controversy and consensus        WANG Quan,TONG Wei-hua,ZHANG Jia-xin. Department of Gastrointestinal Surgery，the First Hospital of Jilin University，Changchun 130021，China
Corresponding author：WANG Quan, E-mail：wangquanjdyy@163.com
Abstract    Lymph node metastasis is the primary route of colorectal cancer metastasis.NCCN，JSCCR and Chinese colorectal cancer diagnosis and treatment standard stipulate that regional lymph node dissection is needed for radical operation on colon cancer，and No.223 and No.253 lymph nodes belong to the regional lymph nodes of left colon cancer.The left branch of the middle colic artery and the left colic artery are the feeding arteries to the splenic flexure，No.223 and 253 lymph node dissection are recommended.The descending colon cancer and sigmoid colon cancer are supplied by the inferior mesenteric artery，only No.253 lymph node dissection is required.At present，some studies think that the low ligation（lymphadenectomy）and high ligation of blood vessels can harvest the same number of lymph nodes and are equally effective in treating malignant tumors.Some studies suggest that high ligation of blood vessels may affect the blood supply of the intestine and increase the occurrence of anastomotic leakage.Thus，it is advocated to maintain the middle colic artery and the inferior mesenteric artery when cleaning No.223 and 253 lymph nodes.Due to the low incidence of left colon cancer，there is little convincing evidence.We look forward to high-level clinical research to further elucidate the scope of lymphadenectomy.

Key words: left colon cancer, lymph node dissection, No.223 lymph nodes, No.253 lymph nodes