摘要
目的探讨肺叶、肺段淋巴结引流的解剖学特征。方法对9具成人尸体采用解剖乳胶填充剂行胸部淋巴结灌注,然后游离标本的纵隔前、纵隔后及中纵隔淋巴结,同时游离并清扫右肺上、中、下肺叶和各个肺段,以及左肺上、下肺叶和各个肺段的肺内淋巴结、肺门淋巴结;观察淋巴结的分布、数目和淋巴回流状况。结果在标本上共观察到212个纵隔淋巴结,平均每例23.5个;各区淋巴结的数目以隆突下淋巴结7区和右下气管旁4R最多,其次为右气管支气管旁(10R)、左支气管旁(10L)和主-肺动脉窗区(5区)淋巴结;纵隔各区以隆突下区(7区)淋巴结最大,其次是右气管支气管旁(10R)淋巴结,气管旁淋巴结自上而下直至隆突下淋巴结逐渐增大,并且右侧大于左侧,即下大于上,右大于左。左肺和右肺的肺内淋巴结一般按照亚段淋巴结→段淋巴结→叶淋巴结→叶间淋巴结/肺门淋巴结;右肺上叶、中叶及肺门淋巴结通常回流至上纵隔淋巴结及隆突下淋巴结,下叶回流至下纵隔淋巴结。而左肺上叶一般引流至主—肺动脉窗区淋巴结及隆突下淋巴结,下叶也引流至下纵隔淋巴结。结论肺叶及纵隔淋巴回流具有一定的规律性,从而为肺叶特异性/系统性淋巴结清扫方式的选择提供了解剖学依据。
Objective To explore the anatomical features of lymph node reflux status for pulmonary lobe and pulmonary segment.
MethodsNine adult cadavers were treated with anatomical latex filler for thoracic lymph node perfusion. Then anterior mediastinum, middle mediastinum, posterior mediastinum lymph nodes were dissected and removed, as well as the upper, middle, lower of the right pulmonary lobe and pulmonary segments, and the upper, lower left pulmonary lobe and pulmonary segments, in addition with hilar lymph nodes. Lymph node distribution, number and lymphatic reflux status were observed carefully. ResultsA total of 212 mediastinal lymph nodes were observed in the specimens, with an average of 23.5. The number of lymph nodes was the highest in the tracheal traction （7） and the lower right trachea （4R）, followed by the right tracheal （10R）, the left bronchus （10L） and the main pulmonary artery window area （5） lymph nodes. The mediastinal area had the largest lymph nodes in the subduction area （7）, followed by the right tracheal bronchial （10R） lymph nodes. Lymph nodes increased gradually, and the right side was greater than the left, which means that the lower was greater than the upper and the right was greater than the left. Left lung and right lung pulmonary lymph nodes were generally in accordance with the sub lymph node→segment lymph nodes→leaf lymph nodes→leaf lymph nodes/hilar lymph nodes and tracheal traction; right upper lobe, middle lobe and hilar lymph nodes usually flowed back to the mediastinal lymph nodes. The lower lobe flowed back to the mediastinal lymph nodes. While the left upper lobe general drained to the main pulmonary artery window lymph nodes and tracheal traction, the lower lobe was also draining to the mediastinal lymph nodes. ConclusionsThe lobar and mediastinal lymphatic reflux has a certain regularity, which provides anatomical basis for the choice of lobular specific/systemic lymph node dissection.
出处
《中华胸部外科电子杂志》
2018年第1期10-15,共6页
CHINESE JOURNAL OF THORACIC SURGERY：Electronic Edition
关键词
肺癌
淋巴结解剖
特异性淋巴结清扫
Lung cancer
Lymph node dissection
Specific lymph node dissection
