Deki H, Sato T
Second Department of Anatomy, Faculty of Medicine, Tokyo Medical and Dental University, Japan.
Surg Radiol Anat. 1988;10(2):121-35. doi: 10.1007/BF02307820.
A detailed study of the lymphatics around the pancreas was carried out in order to provide a theoretic basis for ideal lymph-node resection in radical cancer operations. The following results were obtained as a result of minute macroscopic dissection of the lymphatics. Three major pathways are identified on the anterior surface of the head of the pancreas. The upper pathway belongs to the common hepatic group. The middle and lower routes are associated with the superior mesenteric nodal group. All these pathways terminate in the node situated to the right of the origins of the celiac trunk and the superior mesenteric artery. The lymphatics arising from the neck of the pancreas also converge at the same node. Behind this node, there is a terminal node for the lymphatics which arise from the posterior surface of the head. Both nodes are firmly adherent, with only the nerve plexus of the head of the pancreas intervening. In this study, we have named these lymph-nodes Lnn celiacomesenterici dextri superficialis et profundi. Two distinct pathways are identified in the left half of the pancreas. One follows the splenic blood vessels and the other accompanies the inferior pancreatic artery. By way of these routes, lymphatics from the left half of the pancreas terminate in the node situated to the left of the origins of the celiac trunk and superior mesenteric artery. We have applied the term Ln celiacomesentericus sinister to this node. From these lymphatic terminalis on both sides of the origins of the two arteries, efferent vessels are sent to the abdomino-aortic nodes: on the right side, efferents reach the inter-aorticovenous nodes lying in the upper and lower angles formed by the inferior vena cava and the left renal vein; and on the left side, they arrive at the left latero-aortic nodes lying above and below the left renal vein. The efferents of these nodes then extend to the retro-aortic space, where they compose an ascending lymphatic system. Our study revealed no lymphatic vessels communicating with the retro-aortic system at levels above the renal arteries.
为了给根治性癌症手术中理想的淋巴结切除提供理论依据，对胰腺周围的淋巴管进行了详细研究。通过对淋巴管进行细致的大体解剖，得到了以下结果。在胰头前表面可识别出三条主要路径。上方路径属于肝总淋巴结群。中间和下方路径与肠系膜上淋巴结群相关。所有这些路径都终止于腹腔干和肠系膜上动脉起始部右侧的淋巴结。源自胰颈的淋巴管也汇聚于同一淋巴结。在该淋巴结后方，有一个源自胰头后表面的淋巴管的终末淋巴结。这两个淋巴结紧密相连，中间仅隔着胰头的神经丛。在本研究中，我们将这些淋巴结命名为浅表及深部腹腔肠系膜右淋巴结。在胰腺左半部分可识别出两条不同的路径。一条沿着脾血管走行，另一条伴随胰下动脉。通过这些路径，胰腺左半部分的淋巴管终止于腹腔干和肠系膜上动脉起始部左侧的淋巴结。我们将这个淋巴结称为腹腔肠系膜左淋巴结。从这两条动脉起始部两侧的这些淋巴终末部，发出输出淋巴管至腹主动脉旁淋巴结：右侧的输出淋巴管到达位于下腔静脉和左肾静脉形成的上下角处的主动脉间腔静脉淋巴结；左侧的输出淋巴管到达位于左肾静脉上下方的左外侧主动脉旁淋巴结。这些淋巴结的输出淋巴管然后延伸至主动脉后间隙，在那里它们组成一个上行淋巴系统。我们的研究显示，在肾动脉水平以上没有淋巴管与主动脉后系统相通。
