ABSORBENT VESSELS

From Big Medical Encyclopedia

ABSORBENT VESSELS [vasa lymphatica (PNA, BNA), vasa lymphacea (JNA)] — the endothelial tubes (capillaries) and the thin-walled, having valves vessels of lymphatic system penetrating everything bodies and fabrics closed since one end except a head and spinal cord, a parenchyma of a spleen, epidermis of skin and an epithelial cover of mucous membranes, cartilages, covers of an eyeglobe, lens and a placenta.

History of studying, development of Hp in onto-and phylogenesis — see. Lymphatic system .

Anatomy

Fig. 1. The diagrammatic representation of a structure of a lymphatic bed in a parietal pleura: 1 — lymphatic capillaries of superficial network; 2 — lymphatic capillaries of deep network; 3 — absorbent vessels; 4 — a mesothelium of a pleura; 5 — a connective tissue layer of a pleura; 6 — an internal intercostal muscle.

Lymphatic capillaries begin loops or blind finger-shaped protrusions; they are the beginning (roots) limf, systems and, unlike circulatory capillaries (see), are characterized by tortuosity, uneven contours, existence of lacunas in places of merge. Limf, capillaries, connecting with each other, there are in various size and a form of a loop, forming closed networks lying in body in one or several planes. The very tectonics limf, capillary networks and intraorganic textures of small Hp corresponds to a structure of a parenchyma and a connective tissue stroma and is defined by feature of function of body. Orientation limf, capillaries depends on the direction of bunches of connecting fabric, in to-rykh they lie. In fastion, a derma, mucous and muscular coats, in a submucosa of bodies of digestive, respiratory highways, in urinogenital bodies, in walls of large blood vessels, in serous covers of network limf, capillaries are located in the planes of walls of body (fig. 1).

Connections between networks limf, capillaries of the next layers are not numerous. Networks limf, capillaries in nek-ry bodies blind people of a finger-shaped form have outgrowths; these are the so-called interferruterous sine which are available in a mucous membrane of a stomach central limf, sine — in fibers of a small bowel. In muscles, glands and big parenchymatous bodies (a liver, kidneys, adrenal glands and lungs) of network limf, capillaries have three-dimensional dimensional orientation. Limf. capillaries are located between structurally functional elements of body (hepatic segments, renal little bodies, groups of ferruterous cells, bunches of muscle fibers), forming the loops lying in three mutually perpendicular planes. In functionally more active bodies or parts of bodies lymphatic capillaries are located more densely.

For example, in a mucous membrane of a peloric part and in the field of small curvature of a stomach on the area of 1 mm 2 is available from 50 to 100 limf, sine, and in other departments of a stomach — 20 — 40.

Networks limf, capillaries are reconstructed along with cyclically changing function of body. So, in an ovary the single-layer network limf, capillaries of primary follicles in process of their maturing becomes two-layer. In a stage of vascularization of a yellow body limf, capillaries burgeon to the center of a yellow body, in a stage of blossoming in a yellow body forms central limf, a sine, and in a stage of involution of a yellow body limf, capillaries in it gradually disappear. In a mucous membrane of a uterus, and also in a mammary gland during the premenstrual period increase diameter limf, capillaries and the sizes of loops of network limf, capillaries. During pregnancy in these bodies there is a new growth limf, capillaries, the structure of networks limf, capillaries becomes complicated. New limf, capillaries are formed by budding at the expense of a branch from an endothelium of capillaries of continuous cytoplasmatic outgrowths, in to-rykh kernels share and move ahead; outgrowths are channeled and turn in limf, capillaries.

Fig. 3. The scheme of relationship of circulatory and absorbent vessels of a wall of a small bowel (green color — absorbent vessels, red — arteries, blue — veins, yellow — neuroplex): 1 — a fiber; 2 — an intestinal crypt; 3 — a submucosa; 4 — a ring muscular layer; 5 — a longitudinal muscular layer; 6 — a serous cover; 7 — the central lacteal sine; 8 — network of lymphatic capillaries of a mucous membrane; 9 — network of lymphatic capillaries of a submucosa; 10 — network of lymphatic capillaries around a lymphoid small knot; 11 — a texture of the taking-away absorbent vessels of a submucosa; 12 — arteries of a submucosa; 13 — a vein of a submucosa; 14 — lymphatic capillaries of a ring muscular layer; 15 — the network of lymphatic capillaries located between longitudinal and ring muscular layers; 16 — perineural space of an intermuscular texture; 17 — lymphatic capillaries of a longitudinal muscular layer; 18 — network of lymphatic capillaries of a serous cover; 19 — the taking-away absorbent vessel of a submucosal layer penetrating a muscular coat; 20 — a texture of the taking-away absorbent vessels of a serous cover.

Lymphatic and circulatory capillaries in bodies, as a rule, are in the close topographical relations (tsvetn. fig. 3). Being located in the same connective tissue skeleton of body, they either accompany, or cross each other. In nek-ry bodies an arrangement of lymphatic and circulatory capillaries variously. So, limf, capillaries are absent in hepatic segments, in renal little bodies, in pancreatic islands, between follicles of a thyroid gland, and also in muscle bundles. The network of circulatory capillaries and, as a rule, in serous covers is in skin, mucous membranes closer to a surface of body, than limf, capillaries. Gleams limf, capillaries are not reported neither with circulatory capillaries, nor with serous cavities. Direct coupling limf, capillaries and vessels with blood vessels (veins) - a so-called limfovenozny anastomosis, is not proved, except the place of a confluence limf, trunks (collectors) in veins of a neck. Diameter limf, capillaries fluctuates from 10 to 200 microns. Their walls very rastyazhima therefore the gleam of capillaries at the strengthened receipt of a lymph in them can increase by 2 — 3 times; at the same time also the soaking-up surface limf, capillaries increases. At the lowered lymphopoiesis limf, capillaries can be in the fallen-down state.

Fig. 2. Scheme of a structure of a lymphatic capillary: 1 — a lymphatic capillary (in a section); 2 — anchor filaments; 3 — bunches of collagenic fibers; 4 — endotheliocytes (according to V. F. Shakhlamov, 1971).

Walls limf, capillaries are formed by endotheliocytes, to the Crimea fine ends — the anchor (harmonious) filaments fixing endotheliocytes to adjacent bunches of collagenic fibers of surrounding connecting fabric (fig. 2) are attached. The endothelium is inseparable from surrounding connecting fabric. The connective tissue fibers adjoining an endothelium by means of anchor filaments promote maintenance of capillaries abroach. In usual conditions many of them are in the fallen-down state and are filled with a lymph only at the strengthened lymphopoiesis.

Endotheliocytes of a wall limf, a capillary can have the spindle-shaped, scalloped form or the irregular (intermediate) shape. On impregnirovanny silver drugs as a result of adjournment of silver on borders of endotheliocytes in so-called intercellular cement it is possible to see smooth or scalloped contours of endotheliocytes 30 — 40 microns long; kernels of endotheliocytes have the oval form. In endotheliocytes of a scalloped form of a kernel roundish, and in endotheliocytes of a spindle-shaped form — an elongated and oval form. In cells of the irregular (intermediate) shape of a kernel are located across a body of a cell, a form their various. Endotheliocytes are poor in organellas; cytoplasm has them smaller electron density, than cytoplasm of endotheliocytes of circulatory capillaries. In outside and internal cellular membranes of endotheliocytes limf, capillaries, and also in their cytoplasm many pinotsitozny bubbles are found; on an inner surface the protrusions which are freely acting in a gleam of a capillary of a finger-shaped form — a microvilli are visible.

Ways of connection of endotheliocytes are various. In one cases cytoplasm one endotheliocytes is imposed on edge of other cell; in other cases on cross section of connection of endotheliocytes have the form of a gear seam where protrusions in the form of teeth of one cell come between ledges another, forming the gear or finger-shaped intercellular lock. The gleam of one capillary is limited by two-four endotheliocytes. The basal membrane at limf, capillaries, unlike circulatory, is absent; the main substance of surrounding connecting fabric proceeds in a crack between endotheliocytes.

Absorbent vessels are formed by merge of several limf, capillaries. The place where there is the first valve and appears a thin connective tissue cover around an endothelial tube, is considered to be the beginning limf, a vessel, to-ry has the characteristic chetkoobrazny form. In walls of Hp to dia. 0,2 mm and more between an endothelium and a connective tissue cover appear average — muscular — a cover, edges in process of enlargement of a vessel are thickened. In extra organ Hp there is an internal cover presented by a layer of endotheliocytes, the subject fibrous connecting fabric and single is longitudinal the oriented smooth muscle cells. The average cover consists of one or several rows spiralno of the oriented bunches of smooth muscle cells together with the connective tissue fibers dividing them. In outside, connective tissue, a cover of Hp there are also oriented smooth muscle cells single longwise and even their bunches. The structure of walls of Hp in various departments of a body of the person is unequal and corresponds to conditions of current of a lymph. In Hp of the lower extremities the average (muscular) cover is developed better, than in vessels of upper extremities, the heads and necks. In walls of large Hp there is a blood vessel (vas vasorum lymphaticorum) and a nerve (n. vasorum lymphaticorum) feeding them.

Rice 3. Diagrammatic representation of absorbent vessel (slit): shooters specified valves, by a dotted line — current of a lymph.

Valves in Hp are in places of narrowing of a vessel, intervalve intervals are expanded. Distance between valves in intraorganic Hp — 2 — 3 mm, in extra organ — 6 — 8 mm, and in large limf, vessels (limf, trunks) — 12 — 15 mm. In hypodermic Hp of a leg, from fingers to inguinal limf, nodes, there are about 80 — 100 valves, and in superficial Hp of a hand, from fingers to axillary limf, nodes — 60 — 80 valves. Valves represent, as a rule, the steam rooms lying against each other a semi-lunar form of a fold (shutter) of an internal cover of a wall of Hp (fig. 3).

Yarns of connecting fabric from an outside wall of Hp get into thickness of the valve. Free sites of shutters of valves are turned in proximal (on current of a lymph) the direction. During current of a lymph of a shutter of valves nestle on vascular walls, passing a lymph. Valves interfere with a reversed current of a lymph, edges wrings out shutters of the valve from vascular walls. At the closed valve between a vascular wall and a shutter of the valve there is a pocket of conical shape filled with a lymph, top turned towards the basis of the valve.

The very tectonics and a gistotopografiya of textures of Hp in bodies is defined by structure of body to its connective tissue stroma. Anastomosing with each other, Hp form in bodies of a texture with loops of various form and the sizes. In large loops of textures of Hp loops limf are located, capillaries, to-rye fall into Hp lying a row. In the parenchymatous bodies having a lobular structure (the pancreas, sialadens easy), three-dimensional networks limf of capillaries are as if inserted into the loops of a texture of Hp which are located in connecting fabric between segments of body.

Hp leave body, is more often near blood vessels. Each body or a part of a body leave the taking-away Hp, to-rye go to regional to lymph nodes (see). Hp bringing a lymph in limf a node, are called bringing limf, vessels; and from gate limf, a node there are taking-out Hp. Out of bodies of Hp. (Extra organ) are located, as a rule, as a part of neurovascular bunches - it is deep Hp (vasa lymphatica profunda). Hypodermic Hp — superficial (vasa lymphatica superficialia) — follow to limf, to nodes near saphenas, and also independently. In places of bends of a body of Hp merge with each other or fork (branch), create limf, the collaterals providing free current of a lymph to regional limf, nodes at the changing provision of parts of a body.

Network limf, vessels, regional limf, nodes in bodies and parts of a body — see in articles devoted to bodies and parts of a body (e.g., Lungs , Person etc.).

Physiology

Funkts. value of Hp consists in processes of the lymphopoiesis (drainage function) occurring in limf, capillaries, and the lymph drainage occurring in Hp of different caliber thanks to Krom formed lymph (see) flows in a venous bed.

The lymphopoiesis is caused by a number of factors, among to-rykh the greatest value D. A. Zhdanov (1952) and V. V. Kupriyanov (1975) give to permeability circulatory and limf, capillaries.

For an explanation of process of a lymphopoiesis various theories were offered: filtrational — K. Ludvig (1858), secretory — R. Gey-detayna (1891), Cellular — Asher (L. Ascher, 1898), etc. According to the filtrational theory of Ludwig, after added with E. Starling (1893, 1894), build-up of pressure in circulatory capillaries leads to filtering of liquid from them in fabric, and pressure decline causes inflow (resorption) of liquid from fabric to capillaries; i.e. authors considered that the lymphopoiesis is caused by filtering of the blood plasma in surrounding fabric occurring owing to a difference of hydrostatic pressure between blood in capillaries and an intercellular lymph.

R. Geydengayn established that nek-ry substances (proteins, peptones, a histamine, bacteritic toxins, etc.), promoting a lymphopoiesis, at the same time do not raise, and ABP reduce; he could not explain effect of these substances as well with the osmotic phenomena. Independence of a lymphopoiesis of the size of blood pressure and diffusion gave a reason to R. Geydengayn to consider a lymphopoiesis result of secretory activity of endotheliocytes of circulatory capillaries (but not filterings). R. Geydengayn's experiences which showed independence of lymphization after full obstruction of an aorta and falling in it blood pressure to zero according to D. A. Zhdanov (1952), did not disprove value of filtering for a lymphopoiesis.

Afterwards it was established that the lymphopoiesis depends not only on straining actions and secretion, but also on some other factors. D. A. Zhdanov and V. A. Shakhlamov (1964) established that features of ultra-structure of a wall limf, capillaries and their ratio with surrounding connecting fabric are essential for a lymphopoiesis.

Intercellular cracks of walls limf, capillaries are capable to extend to pass in a gleam of a capillary from the fabrics surrounding it coarse particles — an intercellular way, thanks to Krom various particles pass through a wall limf, capillaries in their gleam (through the closed and open contacts between endotheliocytes). The second way — directly through cytoplasm by formation of mikropinotsitozny bubbles and vesicles — a so-called transendothelial way (see. Pinotsitoz ). Considerably big permeability limf, capillaries (in comparison with circulatory) Kasli-Smith (J. R. Casley-Smith, 1967) explains with the fact that passing in them of liquid and various particles through both called ways happens at the same time. One of the factors promoting a lymphopoiesis is also that endotheliocytes of a wall limf, capillaries are attached to collagenic fibers by anchor filaments, to-rye fix endotheliocytes. Stretching, these structures hold limf, capillaries at hypostasis open while circulatory capillaries at the same time are squeezed.

In a wall limf, capillaries there are closed and open intercellular connections. Through the open intercellular connections (having size from 10 nanometers to 10 microns) in a gleam limf, capillaries, depending on the place of their localization in this or that body, and also from operating conditions of body there can freely pass both large, and fine particles. Endothelium limf. capillaries it is sensitive to various mechanical, thermal and chemical influences changing its permeability.

Features of a structure of a wall limf, capillaries define absorption in limf, capillaries of colloid solutions, suspensions, lipids, various particles of various origin (the bacteria, erythrocytes which left, e.g., at an injury capillaries in fabric, cells of malignant tumors, etc.). As hydrostatic pressure in the arterial site of capillaries is higher, than the colloid osmotic pressure of proteins of a blood plasma, the blood flow through a wall of circulatory capillaries in the main intermediate substance of connecting fabric comes out liquid and crystalloids dissolved in it, i.e. there is biol, filtering. This liquid is not identical to a lymph at all. At the same time through a wall of circulatory capillaries there are also proteins. J. Peleyd (1953), A. Polikar (1976), etc. consider that low-molecular squirrels leave through intercellular spaces (between endotheliocytes of circulatory capillaries), and other molecules of protein — a transendothelial way (vezikulyarno or diffuzno through membranes). Proteins, to-rye were allocated from blood in fabric, and also those, to-rye allocate in an intercellular lymph of a cell of fabric, hl rezorbirutsya. obr. limf, capillaries, as in circulatory capillaries concentration of protein much more, than in the main intermediate substance of connecting fabric.

The factor promoting a lymphopoiesis is increase in colloid osmotic pressure of proteins of an intercellular lymph and lymph. Majority of substances (hl. obr. proteins), got with a filtrate to fabrics, and also allocated with fabrics have rather small pier. weight and therefore increase the kolloidnoosmotichesky pressure of an intercellular lymph (especially in actively functioning body). Increase in colloid osmotic pressure in the main intermediate substance of connecting fabric promotes intensive filtering of liquid from circulatory capillaries in fabric and to an active lymphopoiesis. In the course of a lymphopoiesis through a wall limf, capillaries there is a drainage of fabrics, additional in relation to veins: 80 — 90% of a fabric filtrate are soaked up in a venous bed, 10 — 20% in lymphatic (i.e. absorption of water with the substances dissolved in it, hl. obr. proteins). In limf, capillaries are soaked up also those proteins, to-rye enter the patient at an injection, and also the proteins which are formed at an inflammation, bleeding, damage of fabrics by necrobiotic processes, etc. Structure and physical. - chemical property of a lymph it is normal also of their change at pathology — see. Lymph .

The lymph drainage, i.e. continuous outflow formed in limf, capillaries of a lymph, occurs on limf, to vessels, a chest channel, and also right lymphatic, to jugular and subclavial channels in a venous bed. Along with sokratitelny activity of walls of Hp. The lymph drainage occurs under the influence of active and passive movements of muscles of extremities, fiziol. activities of bodies; it depends on dynamics of permeability of links of a circulatory microcircular bed (see. Mikrotsirkulyation ), conditions of the main intermediate substance of connecting fabric, features of structure and function of endotheliocytes limf, capillaries and them funkts, states.

Force of the pressure head and pushing effect of liquid (vis a tergo), slowly, but the connecting fabric which is continuously getting from the main intermediate substance in limf, capillaries is essential for a lymph drainage. Exchange of liquids between blood and the main intermediate substance of connecting fabric (the last is the colloid which is in a condition of gel) happens on the basis of physical. - chemical patterns of diffusion and osmosis and consequently, depends on a difference between the colloid osmotic pressure of proteins of a blood plasma and proteins of an intercellular lymph, i.e. on effective colloid osmotic pressure. Exchange of the specified liquids depends also on relationship between the effective colloid osmotic pressure of proteins of a blood plasma and hydrostatic pressure, under the Crimea blood moves on a microcirculator bed.

In advance of a lymph, maintenance of a lymph drainage the active role belongs to Hp, the tone of unstriated muscles to-rykh is supported by the regulating influences of a sympathetic nervous system. The movement of a lymph is caused by sokratitelny activity of walls of large, average and small Hp. Reduction of longitudinal muscles two next valves of Hp approach: the peripheral valve under the influence of the return pressure of a lymph is closed, and the central valve opens and passes a lymph, edges is pushed out by reduction of muscles of the interlayer of a wall of Hp. The wave of reductions of longitudinal and spiral muscles extends in the central direction and advances a lymph via serially opening and closed valves. The lymph drainage is promoted also by a number of auxiliary factors: fiziol, activity of bodies, from to-rykh the lymph, reductions of skeletal muscles, prisasyvayushchy activity of a thorax, action of the heart, a pulsation of vessels and the movement of internals flows.

The factors promoting the movement of a lymph are not identical in Hp of various areas of a body (the head and a neck, chest and belly cavities, a top and bottom extremity). Influence of active movements of the extremities strengthening the Lymph drainage depends not only on mechanical impact of skeletal muscles on Hp, but also on changes of blood, especially venous pressure at the movements and, therefore, on conditions of permeability of circulatory microvessels and intensity of products of a lymph. This effect costs also in connection with changes of metabolism in the functioning muscles that leads to strengthening of processes of a lymphopoiesis. The reason of the movement of a lymph in an abdominal cavity consider the intra belly pressure and the movements of bodies went. - kish. a path, creating a direct current of a lymph in belly vessels, and in a chest cavity — a pulsation of an aorta and respiratory fluctuations of intrathoracic pressure. Expansion of a chest channel at a breath and its prelum at an exhalation is connected with features of localization of the lacteal tank of a chest channel (the expanded beginning of a channel) located between legs of a diaphragm (a passive lymph heart of mammals, according to G. M. Iosifov, 1914).

Speed of a lymph drainage is not identical in Hp of different areas of a body, it changes also in various conditions of a lymphopoiesis.

Methods of a research

For judgment about patol, changes of Hp in clinic are usually used survey and a palpation. However the main modern method of a research limf, vessels both in an experiment, and in clinic is the limfografiya with introduction in limf, a bed of contrast agents and radionuclides (see. Limfografiya ).

Pathology

Malformations

Most often meet an aplasia, a hypoplasia, lymphangiectasias of Hp and inborn cysts. Inborn malformations of Hp tend to progressing, causing over time sometimes considerable disturbances. So, e.g., the aplasia of the taking-away Hp which is expressed in lack of Hp in any part of a body leads in sharply expressed elephantiasis of body (see. Elephantiasis ).

Fig. 4. Limfogramma of the lower extremity at an inborn hypoplasia of absorbent vessels: 1 — a shin, 2 — a hip; the only taking-away absorbent vessel is contrasted (it is specified by shooters).

At a hypoplasia the number of Hp can be sharply reduced, sometimes, e.g., throughout all extremity there is one Hp (fig. 4); however the wedge, signs of a hypoplasia can be absent owing to kompensatornoprisposobitelny mechanisms in the beginning (expansion of Hp, a collateral, etc.). With increase funkts, loadings or with age disturbance of a lymph drainage develops that is expressed by hypostasis of fabrics, especially at an inflammation, damage of body.

Inborn cysts of Hp represent the large expansions of a wall of the taking-away Hp (mesenteric, retroperitoneal, a chest channel) which do not have the message with a gleam of a vessel. Contents of such cyst represent milky-white liquid with a large amount of fat or the transparent liquid containing a lot of protein, glucose, chlorides, cholesterol. Cysts can squeeze loops of a gut and cause intestinal impassability, there can be torsion of a leg of a cyst, hemorrhage in a cyst, its gap.

Lymphangiectasia (see) — inborn expansion of Hp is observed as in limf, capillaries, and in vessels, including and in a chest channel; at the same time, unlike inborn cysts, on B. V observations. Petrovsky (1960) and D. Zerbino (1974), lymphangiectasias have the message with a gleam of Hp. Carry to malformations of Hp also lymphangioma (see), edges it is formed in the embryonal period and then slowly increases; comes to light in the early childhood.

Damages

Damages, generally ruptures of Hp, are observed at injury of a thorax, stomach, fractures of vertebras, edges, clavicles at a prelum, falling from height, etc. Damages can be closed when the lymph streams in a perigastrium, and open. Open damages are result of wound fire or cold weapon, open fractures of edges (usually the VII—IX edges with a separation of a pleura). Thus Hp which were less protected by bones, napr, vessels of a neck are more often damaged chest channel (see).

The complete separation large leads Hp to a big fluid loss, protein, salts and other components of a lymph (see. Lymphorrhea ). At the closed damage of Hp the lymph accumulates in cavities: in pleural — chylous hydrothorax (see), belly — hiloperitoneum (see. Peritonitis ), pericardiac — a chilopericardium (see. Pericardium ); besides, the lymph impregnates surrounding soft tissues.

Fig. 5. Limfogramma of a hip at rubtsovotrofichesky disturbances: sharply gyrose absorbent vessels (are specified by shooters) are contrasted, some of them are expanded, others are thinned, as if torn off.

Defeat of Hp in the form of their expressed deformation is observed in hems after thermal, beam burns, injuries, at disturbance of a trophicity of fabrics (fig. 5).

A consequence of damage or the long expressed stagnation of a lymph are limf, fistulas: outside or internal.

Frustration of the Lymph drainage

Renyi-Vamosh (F. Renyi-Vamos, 1960) defines insufficiency limf, systems as a state, at Krom it cannot perform drainage function. He offers the following classification of insufficiency of a lymph drainage. 1. Mechanical insufficiency: a) organic character — a prelum a tumor, the resection of any site limf, systems, cicatricial changes, limfangiit, thrombophlebitis, pyelonephritis, a filariasis, other diseases, e.g. trophedema (see); b) functional character — limfangiospazm (tromboflebitichesky, inflammatory, allergic), hemodynamic (flebogipertonichesky) hypostasis. 2. Dynamic insufficiency: gipoalbu-minemichesky hypostasis at cirrhosis.

Etiol, factors of frustration of a lymph drainage are various, but most often it is the malignant tumors, inflammatory processes, an invasion of parasites, injuries leading to obturation, an obliteration and a compression limf, vessels, the spasm of Hp or their akinetic insufficiency is much more rare. Obturation of Hp arises at a malignant tumor, a filariasis, an obliteration — after a limfangiit of various origin, an injury of Hp and limf, nodes. Insufficiency of a lymph drainage can be a consequence of a sclerosis limf, nodes after rentgeno-or radiotheraphy, a limfografiya and en before lymphatic therapy; sine limf, nodes can be blocked at a lymphogranulomatosis, a lymphosarcoma and a reticulosarcoma. Also the compression of Hp from the outside a tumor, commissures, owing to bandaging of Hp is possible during operations. Considerable disturbances of a lymph drainage develop at the inborn or acquired (essential) insufficiency of Hp (limfangiopatiya) of the lower extremities.

Mechanism of frustration of a lymph drainage and its effects following: an obstacle to current of a lymph — expansion of Hp and sine limf, nodes — increase in a tone of a wall of Hp — delay of current of a lymph — inclusion of collaterals and reserve Hp — insufficiency limf, collaterals — a limfedem — a sclerosis. Only in nek-ry bodies or areas of a body outflow of a lymph can be broken so considerably that arises lymphostasis (see).

Stagnation of a lymph mechanically separates a parenchyma and stromal and vascular components. At the same time the composition of intercellular substance changes, the fabric hypoxia develops, interstitial exchange therefore in fabrics surplus of proteinaceous metabolites and mukosubstantion is created is broken. The most part of the collecting acid mucopolysaccharides — sulphated i.e. those, the Crimea belongs the leading role in processes of a sklerozirovaniye of fabrics.

Insufficiency of a lymph drainage can be acute and chronic. Acute insufficiency — rather short-term process, to-ry usually quickly comes to the end thanks to compensatory and adaptive mechanisms, hl. obr. thanks to disclosure of collaterals. Hron, insufficiency is shown in the form of hypostasis of fabrics with a row consecutive morfol, changes in the wall limf, vessels (a hypertrophy of muscle cells, treatment by a lymph of a wall of vessels, varicosity), increase in quantity limf, capillaries, hypostasis of a stroma of bodies and more or less expressed their sclerosis and cirrhosis. Hron, insufficiency of a lymph drainage in extremities, generative organs conducts to a limfedema and elephantiasis (see). At blockade of a chest channel (extra trunk or intra trunk obstruction by a tumor, parasites, at tuberculosis, an injury) the chylous hydrothorax can develop hiloperitoneum. Insufficiency of a lymph drainage is shown also lymphorrhea (see), chyluria (see).

Diseases

At inflammatory diseases of body in most cases at first expansion limf, capillaries, then their more or less sharp deformation is observed. The outcome in hron, an inflammation, connected with proliferation of connecting fabric, conducts to different degree of an obliteration limf, beds and reductions limf, capillaries. The most widespread disease of Hp is their inflammation (see. Limfangiit ), and also the lymphostasis leading in elephantiasis. Hp are involved in process at tuberculosis limf, nodes, and also at malignant new growths.

Around cancer tumors there is a deformation and expansion limf, capillaries and formation of new. Networks limf, become more dense than capillaries, they get out of a shape inherent in them, orientation of loops disappears, their rezorbtsionny surface increases. It is connected with change of a metabolism in the fabrics surrounding the center of malignant growth. Changes limf, capillaries in tumors depend on specifics of relationship of a parenchyma and a stroma of a tumor.

The principles of treatment at pathology of absorbent vessels. At the inborn and acquired defects of Hp which are followed by loss of a lymph complex recovery and replaceable treatment along with the therapy directed to strengthening of an organism, treatment of inflammatory processes, etc. is carried out. For recovery of water-salt and proteinaceous deficit carry out repeated injections of whole blood or plasma, administration of the liquid received at a puncture of a cavity, in to-ruyu the lymph, in a stomach, a rectum streamed (intravenous administration of such lymph is not recommended; the acute anaphylaxis from the death is described). Plentiful drink, the fat-free diet, etc. is appointed.

The expiration of liquid from Hp in a pleural cavity can stop after several punctures or drainage, a tamponade of a wound. In the absence of effect of such therapy and the progressing exhaustion of the patient resort to operation of bandaging of Hp or recovery of its passability if it was not made during surgical treatment of a wound. The most reliable and easy way of a stop of a lymphorrhea owing to existence of a plentiful anastomosis and paravazalny limf, networks is bandaging of Hp at any level, as a result the cut raises pressure in Hp that promotes disclosure and expansion of collaterals.

With development of microsurgery the possibility of recovery of an integrity of Hp appeared. As specify). V. Petrovsky, V. S. Krylov (1976), it is carried out at damages, organ transplantation, at the same time radical operations of change, prosthetics, anastamosing of Hp and limf, nodes are used. Apply microsurgical tools, optical systems with significant increase and other special devices. Changes of Hp are not numerous. So, Danez (S. of Danese, 1962) managed to make free change of Hp at a dog with implantation of vessels in limf, nodes; Stevens transplanted Hp from an opposite hip and recovered the Lymph drainage.

Fig. 6. Scheme of imposing of an artificial limfovenozny anastomosis: 1 — the tied-up piece of a chest channel; 2 — the lacteal tank of a chest channel; 3 — the imposed anastomosis between a chest channel and an unpaired vein (4); at the left below the tied-up piece of an unpaired vein.
Fig. 7. Scheme of imposing of a limfovenozny anastomosis: and — the big saphena is crossed, its peripheral site is tied up; the lymph node is crossed; — the lymph node is hemmed to a saphena; in — the same operation on an additional saphena; 1 — a big saphena, 2 — an additional saphena, 3 — a lymph node.

It is possible to execute operation of creation of a direct limfovenozny anastomosis (an anastomosis between Hp of a hip and a big saphena of a hip, a chest channel and a vertebral vein, and also between a chest channel and an unpaired vein; fig. 6) though there are instructions that an anastomosis quickly enough is obliterated and become insolvent.

Operations of a vshivaniye crossed limf, nodes in a gleam of a vein, imposing of an anastomosis the end in the end between cut limf, a node and the crossed vein, formation of a limfovenozny anastomosis (fig. 7) are developed; results of such operations are contradictory.

Treatment and prevention of individual diseases of Hp — see articles devoted nozol, to forms (e.g., Limfangiit , Lymphangiectasia , Elephantiasis etc.).



Bibliography:

Anatomy, physiology — see bibliogr, to St. Lymphatic system .

Pathology — Doletsky S. Ya. and Isakov Yu. F. Children's surgery, p.1, M., 1970; Doletsky S. Ya., Gavryushov V. V. and And to about p I am V. G. Hirurgiya's N of newborns, M., 1976; 3 e d-genidze G. A. and C y A. F. Clinical limfografiya, M., 1977, bibliogr.; Zerbino D. D. General pathology of lymphatic system, Kiev, 1974; And yes-tullin I. A. Wounds of a chest lymphatic channel, Surgery, No. 8, page 146, 1976; Isakov Yu. F. and Tikhonov Yu. A. Inborn defects of peripheral vessels at children, M., 1974, bibliogr.; Lymphatic system is normal also of pathology, under the editorship of B. V. Ognev and Yu. E. Vyrenkov, M., 1966; About of N of e in B. V. Simultaneous studying of circulatory, lymphatic, lymphoid and likvorny systems, Surgery, No. 2, page 5, 1971; Panchenkov R. T., etc. Clinical kinds of a structure of terminal department of a chest lymphatic channel, Grudn, hir., No. 6, page 65, 1977; P e of t r about Sunday to y B. V. Hirurgiya of a mediastinum, M., 1960, bibliogr.; Petrovsky B. V. and Krylov of V. S. Mikrokhirurgiya, M., 1976, bibliogr.; Frantsev V. I. To a pathogeny of a postoperative and spontaneous chylous hydrothorax, Grudn, hir., No. 6, page 115, 1963; F r and at the h and V. of X. To results of a tercentenary discussion on a problem of a limfovenozny anastomosis, in book: Vopr, morphology and Eksperim, hir. vascular system, under the editorship of V. of X. Frauch, page 7, Kazan, 1968, bibliogr.; Go dart S. and. lake of Pathologie chirurgicale des vaisscaux lymphatiques, Bruxelles, 1964, bibliogr.; R e n at i - V a-m o s F. Das innere Lymphgefassystem der Organe, Budapest, 1960; Rusznyak I., Foldi M. u. Szabo Gy. Lympho-logie, Physiologie und Pathologie der Lymphgefasse und des Lymphkreislaufes, Budapest, 1969, Bibliogr.


M of P. Sapin; G. S. Satyukova (fiziol), D. D. Zerbino, L. S. Tapinsky (pathology).

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