Visualization of surgical anatomy : digestive organns with special reference to lymphatics

对于胃肠道器官的肿瘤手术，有两个重要但相反的因素需要考虑：根茎清扫和功能保存。由于两者对于取得真正成功的操作结果至关重要，因此必须巧妙地将两者结合起来。为了开发新的综合手术策略，了解淋巴区域解剖的微小细节以及与消化器官的复杂关系至关重要。由于这些复杂关系的实际解剖报告很少，我们对特殊器官的淋巴管进行了详细的解剖，特别参考了它们与自主神经和内脏筋膜的关系，为了外科参考，这些有价值的发现被专业地录制成视频和编辑，并配有日语和英语的旁白。这些视频目前被日本和国外的外科医生使用。第一年，我们主要关注腹主动脉周围的淋巴管以及与主动脉自主神经丛的关系。特别是，视频显示了降路（来自上腹部器官）和升路（来自盆腔器官）在肾血管水平汇合形成胸导管的模式。第二年，解剖的基础是骨盆内部器官到髂淋巴结的外侧淋巴，包括1)骨盆丛的组成和2)分支，以及3)这些器官的内脏筋膜。以上三者与淋巴管的相互关系被清楚地描述和显示出来。在第三年，重点是气管和食管周围的淋巴管，包括与静脉角的收敛方式以及与周围结构的关系。消化器官淋巴管的可视化似乎对外科医生开发根治性手术的新手术技术很有用，这些技术与最终功能的保存和谐结合。少

For cancer surgery of the gastrointestinal organns, there are two important although opposing factors to consider : radical dissection, function preservation. As both are critical to achieve truly successful, operative outocome, both must be skillfully integrated. In order to develop new comprehensive surgical strategies, it is critical to understand the minute details of the regional anatomy of the lymphatics and the complex relationships to the digestive organs. As there are few reports including actual dissection presentation of these complicated relationships, we performed detailed dissecrion of lymphatics of special organs with special reference to their relatinship to the autonomic nerves and visceral fasciae, For surgical reference, these valuable findings were professionally recorded on video and edited, with narration in both Japanese and English languages. These videos are currently in use by surgeons throughout Japan, as well as abroad. In the first year, the dissection vide … More o focused on the lymphatics surrounding the abdominal aorta and the relation to the aoritic autonomic plexus. In particular, the video illustrates the mode of convergence of the descending pathway (from the upper abdominal organs) and the ascending pathway (from the pelvic organs) at the level of the renal vessels to form the thoracic duct. In second year, the dissection was based of the lateral lympahatics from the pelvic internal organs to the iliac nodes, including the 1) composition and 2) ramification of the pelvic plexus, as well as 3) the visceral fascia of these organs. The interrelationships of the above three with the lymphatics were clearly described and shown. In the third year, the emphasis was on the lymphatics surrounding the tranchea and esophagus, including the mode of covergence to the venous angle and the relationships to the surrounding structures. This visualization of the digestive organ lymphatics appears to be useful for surgeons for the development of new surgical techniques for radical operations harmoniously combined with ultimate function preservation. Less