Fourdrain Alex, Lafitte Sophie, Iquille Jules, De Dominicis Florence, Havet Eric, Peltier Johann, Bagan Patrick, Berna Pascal
Department of Thoracic Surgery, Amiens University Hospital, University of Picardy, 80054, Amiens Cedex 01, France.
Laboratory of Anatomy and Organogenesis, Jules Verne University of Picardy, Amiens, France.
Surg Radiol Anat. 2018 Jan;40(1):15-19. doi: 10.1007/s00276-017-1910-3. Epub 2017 Aug 19.
Although peribronchial lymphatic drainage of the lung has been well characterized, lymphatic drainage in the visceral pleura is less well understood. The objective of the present study was to evaluate the lymphatic drainage of lung segments in the visceral pleura.
Adult, European cadavers were examined. Cadavers with a history of pleural or pulmonary disease were excluded. The cadavers had been refrigerated but not embalmed. The lungs were surgically removed and re-warmed. Blue dye was injected into the subpleural area and into the first draining visceral pleural lymphatic vessel of each lung segment.
Twenty-one cadavers (7 males and 14 females; mean age 80.9 years) were dissected an average of 9.8 day postmortem. A total of 380 dye injections (in 95 lobes) were performed. Lymphatic drainage of the visceral pleura followed a segmental pathway in 44.2% of the injections (n = 168) and an intersegmental pathway in 55.8% (n = 212). Drainage was found to be both intersegmental and interlobar in 2.6% of the injections (n = 10). Lymphatic drainage in the visceral pleura followed an intersegmental pathway in 22.8% (n = 13) of right upper lobe injections, 57.9% (n = 22) of right middle lobe injections, 83.3% (n = 75) of right lower lobe injections, 21% (n = 21) of left upper lobe injections, and 85.3% (n = 81) of left lower lobe injections.
In the lung, lymphatic drainage in the visceral pleura appears to be more intersegmental than the peribronchial pathway is-especially in the lower lobes. The involvement of intersegmental lymphatic drainage in the visceral pleura should now be evaluated during pulmonary resections (and especially sub-lobar resections) for lung cancer.
尽管肺的支气管周围淋巴引流已得到充分描述，但脏层胸膜的淋巴引流尚不太清楚。本研究的目的是评估脏层胸膜中肺段的淋巴引流情况。
对成年欧洲尸体进行检查。排除有胸膜或肺部疾病史的尸体。这些尸体已冷藏但未防腐处理。通过手术取出肺并复温。将蓝色染料注入每个肺段的胸膜下区域和第一条引流的脏层胸膜淋巴管。
解剖了21具尸体（7名男性和14名女性；平均年龄80.9岁），平均死亡后9.8天。共进行了380次染料注射（在95个肺叶中）。44.2%（n = 168）的注射中，脏层胸膜的淋巴引流遵循节段性途径，55.8%（n = 212）遵循节段间途径。2.6%（n = 10）的注射中发现引流既有节段间的也有叶间的。在右上叶注射中，22.8%（n = 13）、右中叶注射中57.9%（n = 22）、右下叶注射中83.3%（n = 75）、左上叶注射中21%（n = 21）以及左下叶注射中85.3%（n = 81）的脏层胸膜淋巴引流遵循节段间途径。
在肺中，脏层胸膜的淋巴引流似乎比支气管周围途径更具节段间性，尤其是在下叶。现在在肺癌的肺切除术中（特别是肺叶下切除术）应评估脏层胸膜节段间淋巴引流的情况。
