Kato M
First Department of Surgery, Kyoto Prefectural University of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1995 Feb;96(2):80-7.
Preoperative angiography was performed on 29 patients with remnant stomach cancer. The tumor vessels of the remnant stomach cancer were angiographically identified in 25 patients whose left gastric artery had been left intact (11 cases) or removed (14 cases) in their last operation. Lymph node metastases were examined in relation to the tumor vessels in 96 cases of initial cancer in the upper third of the stomach. Fine activated carbon particles (CH40) were endoscopically injected into the submucosal layer of the stomach in 13 patients with remnant stomach cancer two days before their operation. Blackening of the lymph nodes by CH40 was observed and the effect of removing the left gastric artery on lymphatic drainage was analyzed. Findings from these studies are summarized as follows: In cases of remnant stomach cancer where the left gastric artery was left intact, the tumor vessels most often included the left gastric artery and lymphatic drainage proceeded mainly through the left gastric artery and branches of the splenic artery (the posterior gastric artery, the left gastroepiploic artery, and the short gastric artery) to the para-aortic lymph nodes. In cases where the left gastric artery was removed, the tumor vessels were made up of branches of the splenic artery and lymphatic drainage was mainly through branches of the splenic artery to the para-aortic lymph nodes.
对29例残胃癌患者进行了术前血管造影。在25例患者中通过血管造影识别出了残胃癌的肿瘤血管，这些患者在上次手术中胃左动脉未被切除（11例）或已被切除（14例）。对96例胃上部三分之一处原发性癌患者的肿瘤血管与淋巴结转移情况进行了检查。在13例残胃癌患者手术前两天，通过内镜将细小的活性炭颗粒（CH40）注入胃黏膜下层。观察到CH40使淋巴结变黑，并分析了切除胃左动脉对淋巴引流的影响。这些研究结果总结如下：在胃左动脉未被切除的残胃癌病例中，肿瘤血管最常包括胃左动脉，淋巴引流主要通过胃左动脉和脾动脉分支（胃后动脉、胃网膜左动脉和胃短动脉）至主动脉旁淋巴结。在胃左动脉已被切除的病例中，肿瘤血管由脾动脉分支组成，淋巴引流主要通过脾动脉分支至主动脉旁淋巴结。
