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Das thorakale Lymphsystem – Grundlagen, Besonderheiten und Hinweise für die Praxis

Thoracic lymphatic system—principles, characteristics and advice for the practice

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Zusammenfassung

Das Lymphsystem der Lunge ist komplex. Zur Aufrechterhaltung eines effektiven Gasaustausches bedarf eines dichten lymphatischen Netzwerkes. Die Alveole besitzt keine Lymphgefäße. Ein segmentspezifischer Lymphabfluss besteht nicht. Es existieren für beide Lungen konstante bronchopulmonale Lymphknoten, jedoch sind Anzahl und Größe der Lymphknoten variabel. In unterschiedlicher Ausprägung existieren sieben mediastinale Lymphbahnketten, die als selbständige Einheiten agieren. Zur Erfassung des Nodalstadiums bedarf es einer einfachen reproduzierbaren Dokumentation. Die Einteilung in Kompartimente bzw. Zonen erleichtert dies. Eine mediastinale Lymphknotenmetastasierung ohne Beteiligung bronchopulmonaler Lymphknoten ist möglich. Die Entstehungsmechanismen dieser Skip-Metastasierung sind multifaktoriell.

Abstract

The lymphatic system of the lungs is complex. To maintain an effective gas exchange there is a need for a dense lymphatic network. The alveolae have no lymphatic vessels. There is no segment-specific lymph drainage. For both lungs there are fixed bronchopulmonary lymph nodes but the number and size of the lymph nodes are variable. There are seven mediastinal lymph node chains that vary in extent, each of which acts as an independent functional unit. The accurate assessment of the nodal status needs a simple reproducible nodal map. The division into compartments or zones makes this easier. Mediastinal lymph node metastases without involvement of bronchopulmonary lymph nodes are possible. The development mechanism of this skip metastasizing is multifactorial.

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Authors and Affiliations

  1. Klinik für Thoraxchirurgie, Agaplesion Markus Krankenhaus Frankfurt, Wilhelm-Epstein-Straße 4, 60431, Frankfurt am Main, Deutschland

    M. Schirren, S. Sponholz, G. Karaindros & J. Schirren

  2. Gerhard-Domagk-Institut für Pathologie, Universitätskliniken Münster, Münster, Deutschland

    K.-M. Müller

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  1. M. Schirren
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Correspondence to M. Schirren.

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Interessenkonflikt

M. Schirren, S. Sponholz, G. Karaindros, K.-M. Müller und J. Schirren geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Schirren, M., Sponholz, S., Karaindros, G. et al. Das thorakale Lymphsystem – Grundlagen, Besonderheiten und Hinweise für die Praxis. Chirurg 90, 957–965 (2019). https://doi.org/10.1007/s00104-019-01036-2

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  • DOI: https://doi.org/10.1007/s00104-019-01036-2

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