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在低位直肠癌的外科治疗中,侧方淋巴结清扫的作用观点不一。西方外科专家对包括闭孔窝淋巴结清扫在内的系统的侧方淋巴结清扫持消极态度。2008NCCN中国版直肠癌临床实践指南中明确指出,淋巴结清扫:①尽可能把清扫范围外可疑转移淋巴结切除或活检;②如果无临床可疑转移淋巴结,不推荐扩大的淋巴清扫术。我们认为,只有临床上怀疑有盆腔侧方淋巴结转移病灶才是支持实施侧方淋巴清扫的最佳指标,即实施侧方淋巴清扫的最佳依据是根据术前评估中侧方区域的淋巴结是否肿大。
In the surgical treatment of low rectal cancer, the role of lateral lymph node dissection differ. Western surgical experts hold a negative attitude toward the lateral lymph node dissection of the system, including closed-cell lymph node dissection. 2008NCCN Chinese version of rectal cancer clinical practice guidelines clearly pointed out that lymph node dissection: ① as far as possible to remove the suspicious lymph node dissection or biopsy; ② If there is no clinical suspicious lymph node metastasis, not recommended for extended lymph node dissection. We believe that only clinical suspicion of pelvic lateral lymph node metastases is the best indicator to support the implementation of lateral lymph node dissection, that is, the best basis for the implementation of lateral lymphadenectomy is based on preoperative assessment of lymph nodes in the lateral area is swollen Big.