The nature of the surgical treatment and its results in patients with lung cancer largely depend on the degree and characteristics of the tumor metastases of the tumor of the regional lymphatic collectors. Their removal within healthy tissues is an indispensable condition for ensuring the radicalism of surgical interventions, especially in cases of advanced stages of the development of the disease. Therefore knowledge
the structure of the lymphatic apparatus of the lungs and the pathways of lymph movement through regional collectors is necessary to select, plan and conduct the most optimal oncological option surgical intervention.
Lung tissue is extremely rich in lymphatic vessels, reminiscent of a “swampy lymphatic space” in a figurative manner . There are superficial (intrapleural) and deep (intrapulmonary) lymphatic vessels.
Superficial lymphatic vessels form a large-mesh network, individual loops of which correspond to the outlines of the pulmonary lobules. Each such loop contains 10— smaller pulmonary lobes located on the surface of the bases. It is known that the looping of the lymphatic system of the visceral pleura is less pronounced in the area of less ventilated segments of the lung: apical, posterior and upper-posterior part of the anterior and lateral, basal. The lymphatic system of the diaphragmatic surface of the lungs and lower lobes, especially on the right, is highly developed and represented by wide loops.
The deep lymphatic system of the lungs begins with networks of lymphatic capillaries around the respiratory and terminal bronchioles, in the interacinous and interlobular septa ah . Here, as well as on the subsequent course, they merge with the lymphatic capillaries of the superficial lymphatic network.
Connecting with each other, the lymphatic capillaries form plexus of the discharge lymphatic vessels around the pulmonary arteries, veins, bronchi. As they approach the root of the lung, the lymphatic vessels widely anastomose with each other, forming collector regional lymphatic paths from the lung.
Numerous lymph nodes are included in the regional lymphatic tracts along the lymphatic vessels, which are a kind of filters for foreign particles carried by lymph from the lungs and tumor metastases.
Despite the fact that the location, shape and type of lymph nodes are subject to significant fluctuations, and the range of their individual variability is very large, largely depends on the relationship with adjacent anatomical formations, several main groups of lymph nodes can be distinguished. This is very important in clinical and surgical respects .
Bronchopulmonary lymph nodes are located at the sites of division of the main, lobar and segmental bronchi, peribronchial and perivasal, as well as subpleural between the lobes of the lung. These nodes receive most of the lymph that travels through the lymphatic vessels, which, as they approach the root of the lungs, concentrate mainly around the bronchi and large blood vessels.