Study of Lymphatic Flow in the Remnant Stomach by Endoscopical Injection of Activated Carbon Particles (CH40)

Toshimi Umeno, Tsurayuki Shinohara, Shinnosuke Tanaka, Zentaro Shirai, Hiroshi Kimura, Kazuo Mitsuishi, Seiyo Ikeda

First Department of Surgery, School of Medicine, Fukuoka University

The patients in our study consisted of 2 groups: Group A with 6 patients who had presented with benign disease and subsequently underwent partial gastrectomy (gastroduodenostomy in 3 and gastrojejunostomy in 3); and Group B with 8 patients who had presented with gastric cancer. Five of the 8 subsequently underwent gastroduodenostomy and 3 were subjected to gastrojejunostomy. The 14 patients presented later with remnant stomach gastric cancer. During the subsequent surgery we investigated the lymphatic flow in the remnant stomachs of 14 patients by endoscopically injecting activated carbon particles (CH40) into the lesser curvature and observing the carbon flow. In Group A, the main series of lymphatics was located along the left gastric artery, and the others ran along the splenic artery. In the patients in Group B who had undergone R₂ lymph node dissection, the main lymphatic stream coursed along the splenic artery and left subphrenic artery. In the patients who had undergone gastroduodenostomy, No 12 or No.13 lymph nodes were frequently stained. We therefore believe that new lymphatic pathways were formed. In the gastrodudenostomy cases who had undergone R₃ lymph node dissection, lymph flowed directly towards the stained para-aortic lymph nodes. In the gastrojejunostomy cases who had undergone R₃ lymph node dissection, the mesenteriolum lymph nodes were stained. In conclusion, we found that in patients who had undergone malignant disease surgery, collateral lymphatic flow in the remnant stomach was increased and new lymphatic pathways were found. In addition, the lymphatic flow in patients who had undergone R₂ lymph node dissection was different from those who had undergone R₃, lymph node dissection.

Key words
lymphatic flow, remnant stomach, CH40

Reprint requests
Toshimi Umeno First Department of Surgery, School of Medicine, Fukuoka University
7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-80 JAPAN

Accepted
April 13, 1994

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