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Lymphatic Flow of Gastric Cardia: A study by endoscopic lymphography K. Maruyama 1 1Dept. of Surgery, National Cancer Center Hospital pp.1535-1542
Published Date 1978/11/25
DOI https://doi.org/10.11477/mf.1403107553
  • Abstract
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 Taking advantage of the merit that confluent lymph nodes could be visualized by the endoscopic injection of oily contrast media into the submucosal layer, we observed lymphatic flow from the gastric cardia and upper part of the corpus. We also compared the results with the lymphatic flow as was visualized by dye injection and with the incidence of lymph node metastasis of gastric cancer.

 Lymphography can be made by accurate endoscopic injection of 2~3 ml of Lipiodol emulsionized with Tween 20 into the submucosal layer of the upper body. Plain films of the abdomen were taken one and four days after injection and we conjectured the lymphatic flow by judging how lymph nodes were visualized through exposures of the resected material at operation and especially of the excised lymph nodes. We also observed the dye (Patento blue) circulating in the lymphatic vessels after it had been injected during operation into the subserosal side of the site of lymphography. The results of lymphography were also compared with the rate of metastasis of each lymph node in patients with gastric cancer localized in the C region.

 Lymphography was done in 15 patients. The results of the above-mentioned three studies corresponded well each other. In conclusion, we have assumed that there be three lymphatic flow systems arising from the upper part of the stomach. They are: ―

 A. Ascending flow reaching the mediastium along the esophageal wall.

 B. Right-side flow from the lesser curvature through cardio-esophageal branch and left gastric artery to the celiac artery.

 C. Left-side flow from the posterior wall through the greater curvature and the upper border of the pancreas to the retroperitoneum. Left-side flow is further subdivided into C-1: greater curvature channel from the greater curvature through short gastric arteries, splenic hilus and splenic artery to celiac artery; C-2: posterior gastric channel flowing from the posterior wall of the stomach along ramus esophagogastricus posterior ascendens joining the splenic artery system on the upper margin of the pancreas; C-3: diaphragmatic channel flowing from the fornix, left cardia along the left inferior phrenic artery (esophagocardiac branch) joing directly the para-aortic lymphatics. Our results are considered of great help in lymph node dissection of gastric cancer.


Copyright © 1978, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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