Nagakawa T, Kobayashi H, Ueno K, Ohta T, Kayahara M, Miyazaki I
Second Department of Surgery, Kanazawa University, School of Medicine, Ishikawa, Japan.
Cancer. 1994 Feb 15;73(4):1155-62. doi: 10.1002/1097-0142(19940215)73:4<1155::aid-cncr2820730406>3.0.co;2-h.
At Kanazawa University, the authors have been developing an appropriate radical operation for the treatment of cancer of the head of the pancreas. As a result of previous research, it was believed that lymphatic metastasis of carcinoma of the head of the pancreas should be investigated more thoroughly to improve the surgical results.
Forty-two cases of carcinoma of the head of the pancreas were investigated to determine the distribution of lymphatic metastases. From among these cases, the authors injected activated carbon particles in 10 patients with pancreatic cancer and 111In colloid in seven patients with pancreatoduodenal cancer to investigate the lymphatic spread from the head of the pancreas to the paraaortic lymph nodes (area 16).
The main lymphatic route from the head of the pancrease to lymphatic area 16 was found to pass through the nodes in the posterior part of the head of the pancrease (area 13) and around the superior mesenteric artery (area 14). Lymphatic metastases in area 16 were seen mainly in the lower segment of the middle region from the celiac artery to the inferior mesenteric artery (subarea 16b2). The carbon and 111In colloid flowed mostly to the same area 16 lymph nodes and toward the dorsal side of the renal artery rather than spreading superficially along the abdominal aorta.
These results indicate that area 16 lymph node dissection should be extended toward the dorsal side of the renal artery rather than be performed widely along the abdominal aorta to make the radical operation for pancreatic cancer more extensive.
在金泽大学，作者一直在开发一种适用于治疗胰头癌的根治性手术。先前的研究结果表明，为了提高手术效果，应更彻底地研究胰头癌的淋巴转移情况。
对42例胰头癌病例进行研究，以确定淋巴转移的分布情况。在这些病例中，作者对10例胰腺癌患者注射了活性炭颗粒，对7例胰十二指肠癌患者注射了铟-111胶体，以研究从胰头到腹主动脉旁淋巴结（区域16）的淋巴扩散情况。
发现从胰头到区域16的主要淋巴途径穿过胰头后部（区域13）和肠系膜上动脉周围（区域14）的淋巴结。区域16的淋巴转移主要见于从腹腔动脉到肠系膜下动脉的中区下段（亚区域16b2）。碳和铟-111胶体大多流向同一区域16的淋巴结，并流向肾动脉背侧，而不是沿腹主动脉浅表扩散。
这些结果表明，区域16淋巴结清扫应向肾动脉背侧延伸，而不是沿腹主动脉广泛进行，以使胰腺癌的根治性手术范围更广。
