胃リンパ路廓清術後の修復に関する実験的研究

Abstract

1) The lymphatics and lymph nodes which concerned the drainage of the certain parts of the stomach were visualized with dye solution and removed in nineteen adult mongrel dogs. About two months after the operation, the reparation of the lymph drainage of the stomach was precisely studied.2) Oedema was never seen in the stomach or in the other viscera which had been drained by the removed lymph paths. In the operated sites, the tissue loss had been replaced with scar, and neither lymph cyst nor lymphrrhoe was seen.3) The removed lymph routs were, in general, reconstructed in those normal courses which had been visualized preoperatively, such as the left gastric, the right gastric, the right gastroepiploic, the left gastroepiploic and the fundic rout. However, the lymph drainage through the right gastric rout was seldom reconstructed.4) Usually the lymph drainage was repaired postoperatively through the normal routs. Sometimes, abnormal routs appeared besides the normal routs.5) Most of the postoperative routs were reconstructed in the preoperative course, but a few were visualized only postoperatively, which had not been visualized preoperatively.6) The reconstruction of the preoperatively visualized routs was established by opening of traversing paths through the operated site or of circumventing paths in the pre-existing net of lymphatics. After removal of the lymph paths adjacent to the stomach the reconstruction depended mainly upon circumvention, while after removal of the distant lymph paths mainly upon opening of traversing paths. Commonly to both types of removal, the lymph drainage was reconstructed usually in the original courses as to the regions distal and proximal to the removed site.7) Postoperative opening of the normal routs which had not been visualized preopeoatively was established through circumvention of the removed site via the pre-existing net of anastomosing lymphatics in the stomach wall.8) In the postoperative lymph paths through the normal routs, visualization showed often such morphologic changes of lymphatics as increase in number and dilatation and retrograde migration of dye. These changes appeared to respond to increased resistance in lymph flow.9) Abnormal lymph rout through anastomosing lymphatics, usually not visualized but pre-existing, appeared infrequently. Some of the lymphatics which drained the greater curvature side of the body via the left gastroepiploic rout passed onto the spleno-mesenteric ligament, a part of the greater omentum, and reached to the middle colic lymph nodes.10) When adjacent organs adhered to the removed sites, new formation of connection between the gastric lymphatics and the lymphatics of the adherent organs appeared in an higher percentage only in firm adhesions, and never in loose adhesions. New connection of lymphatics between the gastric remnant and the anastomosed jejunum through gastrojejunostomy stoma was infrequently visualized. Several abnormal lymph routs were established through such new formation of connection between the lymphatics of adherent organs. Of these new routs, the ones through the pancreas, the anastomosed jejunum or the posterior leaf of the greater omentum terminated in the truncus intestinalis or in the rete intestinale, and the one via the right costal part of the diaphragm passed through the sternal lymph node.