気管・食道のリンパ系の局所解剖

Abstract

In function-preserving operations of the esophagus and lung, it is crucial to have a precise knowledge of the mediastinal and deep cervical lymphatics and their relationships to surrounding structures. The lymphatics of the mediastinum and neck, which are associated with the esophagus and run along the trachea, were dissected in detail in several anatomical specimens. The actual photographs taken during the dissection are included for a more complete understanding of the intricate topographical relationships. Although there are numerous transverse connections, the mediastinal lymphatics can be roughly divided into two major ascending pathways: the right and the left. Each pathway can then be subdivided into a superficial pathway along the major blood vessels and a deep pathway along the trachea and esophagus. Various deep right ascending pathways are shown to illustrate the problem of the differing levels at which lymph vesseles leave the paratracheal nodes to reach the right venous angle. Further, the brachiocephalic node group is discussed as the critical intermediary nodes between the superficial and deep pathways. Numerous deep left pathways are also dissected from the left tracheobronchial nodes. Some lymphatics ascend along the left recurrent nerve to finally reach the left venous angle, while some pathways traverse to the right side. Still other pathways directly connect to the thoracic duct.