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

对于胃肠道器官的癌症手术，有两个重要但相互对立的因素需要考虑：根治性切除，功能保留。由于两者都是实现真正成功的、可操作的结果的关键，两者必须巧妙地结合在一起。为了开发新的综合外科手术策略，了解淋巴管局部解剖的细微细节以及与消化器官的复杂关系至关重要。由于包括这些复杂关系的实际解剖介绍的报道很少，我们对特殊器官的淋巴管进行了详细的解剖，特别是考虑到它们与自主神经和内脏筋膜的关系，以供手术参考，这些有价值的发现被专业地记录在视频中并进行编辑，并用日语和英语两种语言叙述。这些视频目前在日本各地以及国外的外科医生中使用。在第一年，解剖视频是…更多的研究集中于腹主动脉周围的淋巴管及其与腹主动脉自主神经丛的关系。特别是，视频显示了下行路径(从上腹部器官)和上升路径(从盆腔器官)在肾血管水平汇聚形成胸腔导管的方式。第二年解剖的基础是从盆腔内脏到髂结处的外侧淋巴分支，包括盆丛的组成和分支，以及这些器官的内脏筋膜。上述三者与淋巴管的相互关系被清楚地描述和显示。术后第3年，重点观察经气管和食道周围的淋巴管，包括与静脉角的融合方式和与周围结构的关系。消化器官淋巴管的这种可视化似乎有助于外科医生开发新的外科技术，使根治性手术与最终功能保留和谐地结合起来。较少

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