Werner J A
Klinik für Hals-, Nasen-, Ohrenheilkunde, Kopf- und Halschirurgie, Universität Kiel.
Laryngorhinootologie. 1995 Oct;74(10):622-8. doi: 10.1055/s-2007-997814.
The understanding of pathological processes involving the lymphatic system of the upper digestive tract requires a detailed knowledge of the lymphovascular architecture of this region.
The lymphatic system of the upper digestive tract was examined in 390 patients by different methods such as light microscopy, electron microscopy, histochemistry, and indirect lymphography.
The mucous membrane of the upper digestive tract is permeated by two communicating lymphatic networks with regionally varying density. There are no areas without lymphatics. The lymphatic fluid of the nasopharynx flows from the posterior wall mainly towards the retropharyngeal and accessory lymph nodes (level II). The lymphatic flow from the buccal mucous membrane, the anterior floor of the mouth, the oral tongue, and the hard palate mostly drains toward the submandibular and craniojugular areas. Lymphatic fluid from the tonsils, the soft palate, and the hypopharynx flows primarily to the deep cervical lymph nodes (level II and III).
These results are a basis for the understanding of a) secondary lymphatic edemas and b) frequency and direction of lymphogenous metastasis of carcinomas in this region. The direction of metastasis usually follows the physiologic lymphatic drainage. Metastasis towards untypical areas can in most cases be explained by an alteration of the lymphatic flow secondary to inflammation, radiotherapy, previous surgery, and subsequent scar formation or tumor growth.
要了解涉及上消化道淋巴系统的病理过程，需要详细掌握该区域的淋巴管结构。
采用光学显微镜、电子显微镜、组织化学和间接淋巴管造影等不同方法，对390例患者的上消化道淋巴系统进行检查。
上消化道黏膜有两个相互连通的淋巴网络，其密度因区域而异。不存在无淋巴管的区域。鼻咽部的淋巴液主要从后壁流向咽后和副淋巴结（II区）。颊黏膜、口腔前底部、口舌和硬腭的淋巴液大多引流至下颌下和颅颈区。扁桃体、软腭和下咽的淋巴液主要流向颈深淋巴结（II区和III区）。
这些结果是理解以下两方面的基础：a）继发性淋巴水肿；b）该区域癌的淋巴源性转移的频率和方向。转移方向通常遵循生理性淋巴引流。在大多数情况下，向非典型区域的转移可解释为炎症、放疗、既往手术以及随后的瘢痕形成或肿瘤生长导致的淋巴液流动改变。
