Shimada K, Fujii M, Sato H, Tanaka T, Murakami G, Goto N
Department of Anatomy, Showa University School of Medicine, Tokyo, Japan.
Kaibogaku Zasshi. 1995 Feb;70(1):11-9.
The lymphatics on the thoracic surface of the diaphragm, especially lying around the lateral and posterior sides of the base of the cardiac sac, were examined in 68 adult Japanese cadavers macroscopically (37 males and 24 females, aged 45-92 years, no clinical evidences of neoplasms). In this observation, a vein which drained into the terminal portion of the inferior vena cava was observed. The lymph nodes in this region were located along the vein frequently (80.9%). The vein passed through the esophageal hiatus, or penetrated the diaphragm and finally communicated with veins around the esophagogastric junction. However, lymphatic vessels were not observed passing through the phrenico-esophageal membrane and/or the diaphragm. The collecting vessels, which originated from the lymphatics, drained into the esophageal lymphatics, and it drained into the thoracic duct via the esophageal lymphatics. In pleural effusion cases, lymphatic nets were clearly observed on the thoracic surface of the diaphragm immediately under the parietal pleura. The lymphatic nets did not communicate with the diaphragmatic lymphatics around the base of the cardiac sac. Moreover, large collecting vessel from the lymphatic nets passed through the muscular crus of the diaphragm near the medial arcuate ligament and traveled inferior to merge at the original portion of the thoracic duct at the level of the renal vessels. From these observations, the lymphatics on the posterior part of the thoracic surface of the diaphragm communicated with several regional lymphatics independently. This morphological lymphatic traveling suggests that the route differs in cases of pleural effusion or cancer metastasis.
在68具日本成年尸体（37例男性和24例女性，年龄45 - 92岁，无肿瘤临床证据）上，对膈胸面的淋巴管，尤其是位于心包底部外侧和后侧周围的淋巴管进行了宏观检查。在此次观察中，发现一条静脉汇入下腔静脉末端。该区域的淋巴结常沿此静脉分布（80.9%）。这条静脉穿过食管裂孔，或穿透膈肌，最终与食管胃交界处周围的静脉相通。然而，未观察到淋巴管穿过膈食管膜和/或膈肌。起源于淋巴管的集合管汇入食管淋巴管，并通过食管淋巴管汇入胸导管。在胸腔积液病例中，在紧贴壁胸膜下方的膈胸面上可清晰观察到淋巴管网。这些淋巴管网与心包底部周围的膈淋巴管不相通。此外，来自淋巴管网的大集合管穿过靠近内侧弓状韧带的膈肌肌脚，下行至肾血管水平处与胸导管起始部汇合。基于这些观察结果，膈胸面后部的淋巴管独立地与多个区域的淋巴管相通。这种形态学上的淋巴引流路径表明，胸腔积液或癌症转移时的路径有所不同。
