Sawai K, Azuma T, Matsuda K, Izumi H, Niwa M, Kato G, Takenaka A, Tokuda H
Nihon Geka Gakkai Zasshi. 1984 Feb;85(2):143-52.
Celiac, left gastric, common hepatic and superior mesenteric angiography was performed in 296 gastric cancer patients. Relationship between anatomical variations and the mode of lymphatic metastasis was discussed. The emergence of right gastric artery was from hepatic artery proper in 46.9%, right, middle and left hepatic in 26.4%, common hepatic and gastroduodenal in 18.6%, and others in 5.4%. The rate of metastasis to suprapyloric nodes was the highest (20.0%) among the cases, in which the right gastric artery was given off distal to the hepatic artery proper. Left gastric artery emerged from the celiac in 94.9%, splenic in 2.7%, abdominal aorta in 2.1%, and common hepatic in 0.3%. Knowledge of the origin of the arteries is essential to thorough dissection of the perivascular lymph nodes. The accessory hepatic arteries emerged from left gastric artery in 17.9% of the cases, in which the rate of lymph node metastasis along left gastric artery was higher than others. Left gastric artery should be severed at its point of emergence for thorough dissection of lymph nodes along this artery in gastric cancer. However, the fact that 20.8% of accessory left hepatic arteries were perfusing more than 2 liver segments must be into consideration.
对296例胃癌患者进行了腹腔干、胃左动脉、肝总动脉和肠系膜上动脉造影。讨论了解剖变异与淋巴转移方式之间的关系。胃右动脉起源于肝固有动脉的占46.9%，起源于肝右、中、左动脉的占26.4%，起源于肝总动脉和胃十二指肠动脉的占18.6%，其他起源的占5.4%。在胃右动脉起源于肝固有动脉远端的病例中，幽门上淋巴结转移率最高（20.0%）。胃左动脉起源于腹腔干的占94.9%，起源于脾动脉的占2.7%，起源于腹主动脉的占2.1%，起源于肝总动脉的占0.3%。了解动脉起源对于彻底清扫血管周围淋巴结至关重要。17.9%的病例中副肝动脉起源于胃左动脉，其中沿胃左动脉的淋巴结转移率高于其他情况。在胃癌手术中，为彻底清扫沿胃左动脉的淋巴结，应在胃左动脉起始处切断。然而，必须考虑到20.8%的副左肝动脉供血超过2个肝段这一事实。
