Department of Digestive Surgery, Vestfold Hospital Trust, Postbox 2168, 3103, Tønsberg, Norway.
Department of Cellular Physiology and Metabolism, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Surg Endosc. 2018 Sep;32(9):3806-3812. doi: 10.1007/s00464-018-6106-3. Epub 2018 Feb 12.
There has been a lengthy discussion on the extent of lymphatic resection for right-sided colon cancer and the central borders of the mesentery that are not yet defined. The objectives of this study are to define minimal clearances for adequate lymphatic resection in regard to colic artery origins and the superior mesenteric artery (SMA) and vein (SMV) relevant to right colectomy.
Central mesenteric lymph vessels, nodes, and blood vessels were dissected in 16 cadavers. Cranial-caudal clearances were defined as distances between an individual colic artery origin (ileocolic, right colic, and median colic artery) and the outermost lymphatic vessel within its lymphovascular bundle, cranial and caudal along the SMA. Long lymphatic vessels crossing the SMV between arterial bundles were counted and they constituted the medial clearances. An arbitrary watershed between small bowel and colonic lymph was localized. Immunohistochemistry was performed to histologically verify lymphatic vessels.
Cranial-caudal clearances were ileocolic 3.6 ± 1.9 and 5.7 ± 1.9; right colic 2.8 ± 1.6 and 3.3 ± 1.0; middle colic artery bundle 6.3 ± 2.7 and 5.9 ± 2.4 mm, respectively. Long lymphatic vessels crossing the SMV between arterial buntles and approaching the SMA were found in all cadavers (antero/posteriorly in 12, only anteriorly in 4), median 3.5 (1-7) long lymphatic vessels anteriorly, and 1.5 (0-5) posteriorly per cadaver.
Right colonic lymphovascular bundles are volumes of mesenteric tissue that surround the superior mesenteric vessels anteriorly and posteriorly. Long lymphatic vessels traverse the superior mesenteric vein anteriorly/posteriorly approaching the superior mesenteric artery between arterial bundles and placing the medial clearance on the left side of the artery. These do not correlate to arterial crossing patterns. Cranial-caudal clearances determine the tissue to be removed superior/inferior to arterial origins together with long lymphatic vessels transversing independently between the lymphovascular bundles placing the weight of lymphatic resection on the mesenteric tissue and not on the level of vessel division (High tie).
对于右侧结肠癌的淋巴切除范围以及尚未明确界定的肠系膜中央边界，一直存在着长时间的讨论。本研究的目的是确定与右结肠切除术相关的结肠动脉起源以及肠系膜上动脉（SMA）和静脉（SMV）的适当淋巴切除的最小清除范围。
在 16 具尸体中解剖了中央肠系膜淋巴管、淋巴结和血管。头尾部清除距离定义为单个结肠动脉起源（回结肠、右结肠和中结肠动脉）与淋巴血管束内最外层淋巴管之间的距离，沿 SMA 头尾部。在动脉束之间穿过 SMV 的长淋巴管被计数，它们构成了内侧清除距离。在小肠和结肠淋巴之间定位任意分水岭。进行免疫组织化学以组织学验证淋巴管。
头尾部清除距离分别为回结肠 3.6±1.9 和 5.7±1.9；右结肠 2.8±1.6 和 3.3±1.0；中结肠动脉束 6.3±2.7 和 5.9±2.4mm。在所有尸体中均发现穿过 SMV 的长淋巴管并靠近 SMA（12 具尸体中前/后向，4 具尸体中仅前向），平均每具尸体有 3.5（1-7）条长淋巴管向前，1.5（0-5）条向后。
右结肠血管淋巴束是围绕肠系膜上血管前后的肠系膜组织体积。长淋巴管在动脉束之间从前/后向穿过肠系膜上静脉，靠近动脉，在动脉的左侧形成内侧清除距离。这些与动脉交叉模式无关。头尾部清除距离决定了要与动脉起源一起切除的组织的上下位置，同时独立地穿过淋巴管之间的长淋巴管，将淋巴切除的重量放在肠系膜组织上，而不是在血管分离的水平上（高位结扎）。
