从精细解剖学角度分析直肠癌手术清扫No.253淋巴结难点与技巧OA

In radical surgery for rectal cancer,the completeness of regional lymph node dissection is closely associated with the accuracy of tumor staging and long-term oncological outcomes.The No.253 lymph node,located at the root of the inferior mesenteric artery,represent a critical pathway for the upward spread of rectal cancer from regional to central lymphatic drainage.However,due to the complex anatomical structures and marked individual variations in this region,the dissection of No.253 lymph node has long been regarded as one of the most technically demanding and high-risk aspects of rectal cancer surgery.In recent years,with the increasing application of the concept of precise anatomy in colorectal surgery,a deeper understanding of the anatomical planes and tissue composition in this area has been achieved,providing a solid theoretical basis for the safe and effective dissection of No.253 lymph node.The key to No.253 lymph node dissection lies in precise recognition of the retroperitoneal anatomy.The No.253 lymph node area should be regarded as an independent three-dimensional anatomical unit,and regional en bloc dissection should be performed along the inferior mesenteric artery within the pre-aortic fascial plane.A standardized surgical approach facilitates complete lymph node dissection while minimizing bleeding and nerve injury,thereby balancing oncological radicality with postoperative functional preservation.