Department of Gatroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan,
Gastric Cancer. 2013 Oct;16(4):615-20. doi: 10.1007/s10120-012-0229-3. Epub 2013 Jan 13.
We focused on the embryology and topographic anatomy of the infrapyloric lymph region, which is frequently involved in node metastases but technically complicated for dissection in gastric cancer surgery. Gastrointestinal organs possess their own mesenteries composed of double layers of peritoneum that enclose the intermediate adipose layer providing pathways for vessels, nerves, and lymphatic channels. The frontal layer of the mesoduodenum, in which no. 6 infrapyloric nodes lie, directly faces the pancreas and during gestation is overlain by the greater omentum and transverse mesocolon through the membranous connective tissue called the fusion fascia. Therefore, we performed no. 6 node dissection using the following process: (1) we traced out the mesoduodenum by detachment of the greater omentum and transverse mesocolon; (2) we transected the fusion fascia and (3) removed the adipose layer on the anterior face of the pancreas with its included lymph nodes together with the right gastroepiploic and infrapyloric vessels. The described technique is feasible and in keeping with the anatomical logic for oncologically reliable dissection of no. 6 infrapyloric nodes.
我们专注于胃下区域的胚胎学和局部解剖，该区域在胃癌手术中经常涉及淋巴结转移，但在技术上解剖较为复杂。胃肠道器官具有自己的系膜，由双层腹膜组成，其中包含中间脂肪层，为血管、神经和淋巴管提供了途径。十二指肠系膜的前层，即第 6 胃下区域淋巴结所在的位置，直接面对胰腺，在妊娠期间，通过称为融合筋膜的膜状结缔组织被大网膜和横结肠系膜覆盖。因此，我们使用以下过程进行第 6 淋巴结清扫：（1）通过分离大网膜和横结肠系膜，追踪十二指肠系膜；（2）横断融合筋膜；（3）切除胰腺前脂肪层及其包含的淋巴结，同时切除右胃网膜和胃下血管。所描述的技术是可行的，符合第 6 胃下区域淋巴结进行肿瘤学可靠解剖的解剖学逻辑。
