Kawabata A, Hamanaka Y, Suzuki T
Department of Surgery II, Yamaguchi University School of Medicine, Japan.
Hepatogastroenterology. 1998 Jan-Feb;45(19):236-41.
BACKGROUND/AIMS: Periampullary cancer frequently metastasizes to the lymph nodes around the superior mesenteric artery. Simultaneous dissection of the nerve plexus around the SMA, however, often results in intractable diarrhea. This study was performed to examine the extent to which regional lymph nodes may be dissected while preserving the superior mesenteric nerve plexus during radical surgery for periampullary cancer.
The pancreas and surrounding tissue from ten adult autopsied subjects were sectioned at 5 mm intervals. The structure of the nerve plexus and the distribution of the lymph nodes were analyzed, and the anatomical relationship between the nodes and the nerve plexus was investigated.
The average thickness of the PLsma was 4.2 +/- 1.3 mm, becoming thinner from the root to the periphery. The lymph nodes were distributed uniformly on the right and left hemicircles of the superior mesenteric artery and along its longitudinal axis. The average number of lymph nodes was 14.2 +/- 7.5 per subject, and the average maximum node diameter was 3.3 +/- 2.3 mm. The distance from the adventitia of the superior mesenteric artery to the node was 5.5 +/- 2.0 mm. Of a total of 142 lymph nodes, 134 (94.4%) were located outside of the nerve plexus.
Dissection of the superior mesenteric lymph nodes while preserving the superior mesenteric nerve plexus is theoretically possible.
背景/目的：壶腹周围癌常转移至肠系膜上动脉周围的淋巴结。然而，同时清扫肠系膜上动脉周围的神经丛往往会导致顽固性腹泻。本研究旨在探讨在壶腹周围癌根治性手术中，在保留肠系膜上神经丛的同时可清扫区域淋巴结的范围。
对10例成年尸检对象的胰腺及周围组织每隔5毫米进行切片。分析神经丛的结构和淋巴结的分布，并研究淋巴结与神经丛之间的解剖关系。
肠系膜上动脉周围神经丛的平均厚度为4.2±1.3毫米，从根部到周边逐渐变薄。淋巴结均匀分布在肠系膜上动脉的左右半圈及其纵轴上。每位受试者的淋巴结平均数量为14.2±7.5个，淋巴结平均最大直径为3.3±2.3毫米。从肠系膜上动脉外膜到淋巴结的距离为5.5±2.0毫米。在总共142个淋巴结中，134个（94.4%）位于神经丛之外。
在保留肠系膜上神经丛的同时清扫肠系膜上淋巴结在理论上是可行的。
