Lymphatic drainage of the peritoneal space: A pattern dependent on bowel lymphatics
Lymphatic drainage of the peritoneal space: A pattern dependent on bowel lymphatics
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DOI：
10.1245/s10434-006-9044-6
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发表时间：
2007-02-01
影响因子：
3.7
通讯作者：
Frangioni, John V.
中科院分区：
文献类型：
--
作者：
Parungo, Cherie P.;Soybel, David I.;Frangioni, John V.
背景：了解腹膜淋巴引流模式有助于胃肠道和卵巢恶性肿瘤的分期和治疗。前哨淋巴结（sln）已被确定为实体器官和胸膜间隙。我们的目的是确定腹膜间隙是否有可预测的淋巴结引流模式。方法：大鼠腹腔注射近红外（NIR）荧光示踪剂，即量子点（专为SLN保留）或人血清白蛋白结合IRDye800 （HSA800，专为SLN外淋巴流动设计）。定制成像系统在注射后10分钟和20分钟以及1、4和24小时检测近红外荧光。为了确定脏器对腹膜淋巴流动的贡献，另外的队列在近红外示踪剂注射前接受肠切除术。采用chi(2)检验评估与适当对照的相关性。结果：量子点引流至腹腔、肠系膜上、门静脉周围淋巴结组。HSA800在早期时间点引流到这些组，但继续通过胸导管流入纵隔淋巴结。肠切除术后，两种示踪剂均出现在胸部淋巴结组，而非腹部淋巴结组。此外，HSA800不再在胸导管中发现，而是在前胸壁和膈淋巴管中发现。结论：腹膜间隙首先流向腹腔、肠系膜上、门静脉周围淋巴结组。淋巴继续通过胸导管进入纵隔淋巴结。肠淋巴管是腹膜淋巴流动的关键决定因素，因为肠切除术将淋巴管通过胸壁淋巴管直接转移到胸内淋巴结。
Background: Understanding lymph drainage patterns of the peritoneum could assist in staging and treatment of gastrointestinal and ovarian malignancies. Sentinel lymph nodes (SLNs) have been identified for solid organs and the pleural space. Our purpose was to determine whether the peritoneal space has a predictable lymph node drainage pattern.Methods: Rats received intraperitoneal injections of near-infrared (NIR) fluorescent tracers: namely, quantum dots (designed for retention in SLNs) or human serum albumin conjugated with IRDye800 (HSA800; designed for lymphatic flow beyond the SLN). A custom imaging system detected NIR fluorescence at 10 and 20 minutes and 1, 4, and 24 hours after injection. To determine the contribution of viscera to peritoneal lymphatic flow, additional cohorts received bowel resection before NIR tracer injection. Associations with appropriate controls were assessed with the chi(2) test.Results: Quantum dots drained to the celiac, superior mesenteric, and periportal lymph node groups. HSA800 drained to these same groups at early time points but continued flowing to the mediastinal lymph nodes via the thoracic duct. After bowel resection, both tracers were found in the thoracic, not abdominal, lymph node groups. Additionally, HSA800 was no longer found in the thoracic duct but in the anterior chest wall and diaphragmatic lymphatics.Conclusions: The peritoneal space drains to the celiac, superior mesenteric, and periportal lymph node groups first. Lymph continues via the thoracic duct to the mediastinal lymph nodes. Bowel lymphatics are a key determinant of peritoneal lymph flow, because bowel resection shifts lymph flow directly to the intrathoracic lymph nodes via chest wall lymphatics.