Kayahara M, Nagakawa T, Kobayashi H, Mori K, Nakano T, Kadoya N, Ohta T, Ueno K, Miyazaki I
Second Department of Surgery, School of Medicine, Kanazawa University, Japan.
Cancer. 1992 Oct 15;70(8):2061-6. doi: 10.1002/1097-0142(19921015)70:8<2061::aid-cncr2820700808>3.0.co;2-v.
The lymphatic pathway from the head of the pancreas to the para-aortic lymph nodes was examined on the basis of the frequency of lymph node involvements. Forty-four patients were examined. All patients had extended radical operations. Thirty-one of 44 (70.5%) patients had lymph node involvement. The lymph nodes that had a high metastatic rate included the following: (1) lymph nodes around the common hepatic artery (number 8 lymph node); (2) lymph nodes of the hepatoduodenal ligament (number 12 lymph node); (3) the posterior pancreaticoduodenal lymph node (number 13 lymph node); (4) lymph nodes around the superior mesenteric artery (number 14 lymph node); (5) para-aortic lymph nodes (number 16 lymph node); and (6) the anterior pancreaticoduodenal lymph node (number 17 lymph node). Twenty-eight of these 31 patients had disease in the posterior pancreaticoduodenal lymph node. The patterns of lymph node involvement consisted of four combinations: number 13-number 17, number 13-number 14, number 14-number 16, and number 17-number 8. All of the patients with number 16 nodal involvement had number 14 lymph node metastasis. However, there was no relationship between tumor size and lymph node involvement. Based on these results, the main lymphatic pathway from the head of the pancreas to the para-aortic lymph nodes was thought to be via the lymph nodes around the superior mesenteric artery, assuming that lymphatic flow is anterograde. In addition, this study demonstrates that it is necessary to perform an extensive lymph node dissection, including the para-aortic lymph node, even in patients with small tumors.
基于淋巴结受累频率，对胰腺头部至腹主动脉旁淋巴结的淋巴引流途径进行了研究。共检查了44例患者。所有患者均接受了扩大根治性手术。44例患者中有31例（70.5%）出现淋巴结受累。转移率较高的淋巴结包括：（1）肝总动脉周围淋巴结（第8组淋巴结）；（2）肝十二指肠韧带淋巴结（第12组淋巴结）；（3）胰十二指肠后淋巴结（第13组淋巴结）；（4）肠系膜上动脉周围淋巴结（第14组淋巴结）；（5）腹主动脉旁淋巴结（第16组淋巴结）；（6）胰十二指肠前淋巴结（第17组淋巴结）。这31例患者中有28例胰十二指肠后淋巴结受累。淋巴结受累模式包括四种组合：第13组-第17组、第13组-第14组、第14组-第16组和第17组-第8组。所有第16组淋巴结受累的患者均有第14组淋巴结转移。然而，肿瘤大小与淋巴结受累之间无相关性。基于这些结果，假定淋巴液为顺行流动，胰腺头部至腹主动脉旁淋巴结的主要淋巴引流途径被认为是经肠系膜上动脉周围淋巴结。此外，本研究表明，即使是小肿瘤患者，也有必要进行广泛的淋巴结清扫，包括腹主动脉旁淋巴结清扫。
