Nagakawa T, Mori K, Kayahara M, Ohta T, Ueno K, Sanada H, Miyazaki I
Second Department of Surgery, School of Medicine (School of Allied Professions), Kanazawa University, Ishikawa, Japan.
Int J Pancreatol. 1994 Apr;15(2):129-88. doi: 10.1007/BF02924663.
The anatomy and topography of tissue surrounding the superior mesenteric artery were examined histopathologically, and the structure surrounding the superior mesenteric artery (SMA) was reconstructed with data from histologic examination and three-dimensional analyses. Specimens were obtained from three autopsy cases without abnormalities, two surgically resected cases of cancer of the pancreatic head, and one autopsy case of cancer of the pancreatic head. The endothelium or basal membrane of blood and lymph vessels were identified immunohistochemically, and the distribution of lymph nodes, blood vessels, lymph vessels, and collagen fibers was determined. The superior mesenteric plexus was found to be a relatively dense structure with a thickness of about 2 mm, composed of collagen fibers and connective tissue, which concentrically enveloped the small arteries, the superior mesenteric artery, nerve bundles, and capillaries. Lymph vessels larger than a few micrometers in diameter were often found outside of the plexus, and this plexus contained no lymph nodes in any sections. The three-dimensional study of the modes of spread along the superior mesenteric artery of pancreatic cancer revealed two types of spread: the tumor extends mainly by neural invasion, and the tumor extends mainly by lymph node metastases. These morphologic features suggest that lymphatic flow in the vicinity of the superior mesenteric artery passes primarily outside of the plexus, and complete excision of lymph nodes close to the superior mesenteric artery with preservation of the superior mesenteric plexus is feasible if there is no neural invasion into retropancreatic tissues.
对肠系膜上动脉周围组织的解剖结构和局部解剖进行了组织病理学检查，并利用组织学检查和三维分析的数据重建了肠系膜上动脉（SMA）周围的结构。标本取自3例无异常的尸检病例、2例胰头癌手术切除病例和1例胰头癌尸检病例。通过免疫组织化学方法鉴定血管和淋巴管的内皮或基底膜，并确定淋巴结、血管、淋巴管和胶原纤维的分布。发现肠系膜上神经丛是一个相对致密的结构，厚度约为2mm，由胶原纤维和结缔组织组成，同心包裹着小动脉、肠系膜上动脉、神经束和毛细血管。直径大于几微米的淋巴管常出现在神经丛外，且在任何切片中该神经丛均未发现淋巴结。胰腺癌沿肠系膜上动脉扩散方式的三维研究显示出两种扩散类型：肿瘤主要通过神经侵犯扩散，以及肿瘤主要通过淋巴结转移扩散。这些形态学特征表明，肠系膜上动脉附近的淋巴流主要通过神经丛外，并且如果没有神经侵犯胰后组织，保留肠系膜上神经丛并完整切除靠近肠系膜上动脉的淋巴结是可行的。
