LYMPHATIC SYSTEM

From Big Medical Encyclopedia

LYMPHATIC SYSTEM [systema lymphaticum (PNA, BNA); vasa lymphacea (JNA)] — the system of lymphatic capillaries, small and large absorbent vessels and the lymph nodes which are on their course providing together with veins a drainage of bodies, i.e. absorption from fabrics of water, colloidal solutions of proteins, emulsions of the lipids dissolved in water of crystalloids, removal from fabrics of decomposition products of cells, microbic bodies and other particles and also limfotsitopoetichesky and protective functions.

History

«white blood» and a colorless liquid was mentioned by Hippocrates and Aristotle. Later B. Evstakhy (1564) found and described a chest channel at a horse, having called it a white chest vein since took it for the vessel feeding a trunk.

Actually opening limf, vessels belongs to Azelli (G. Aselli, 1581 — 1626) who saw and described milk (lymphatic) vessels of a mesentery at a dog. Limf, vessels and a chest channel at the person for the first time investigated to Peca (J. Pecquet, 1651). Almost at the same time chest channel at a dog was described by Wang Horn (J. van Horn, 1652). The first quite detailed description limf, vessels, including and their valves, belongs to Rudbek (O. of Rudbeck, 1653) who executed a large number of openings and Bartolin (T. Bartholin, 1653) studied limf. vessels of a liver. This researcher offered the terms «chest channel», «absorbent vessels». Right limf, the channel, and also the valve in the mouth of a chest channel was opened in 1662 by N. Stenon.

Further progresses in a research of Hp were made in connection with use of a method of an injection limf, vessels mercury, offered by Nuk (A. Nuck, 1692).

The description of Hp fullest for those times, including and a chest channel, is available in A. Galler (1765) books, Mascagni (P. Mascagni, 1787), Krukshenka (W. Page of Cruikshank, 1789). At the end of 18 and in 19 century details of a structure of Hp were specified, the discussion about existence of connections between limf was conducted, and the circulatory bed, put forward various theories of lymphization (see. Absorbent vessels ).

Great interest to Hp was shown in 20 century in connection with identification of its role in transfer of contagiums and cells of tumors, its participations in a metabolism. There were detailed descriptions of Hp at a number of animals, generalizations of the numerous new facts about a structure of Hp at the person [P. Bartels, 1909; G. M. Iosifov, 1914; H. Rouviere]. Especially big contribution to studying of anatomy of Hp was made by the Soviet scientists D. A. Zhdanov, E. Ya. Vyrenkov, M. S. Spirov, etc.

In the middle of 20 century the structure of Hp and capillaries, the mechanism of permeability of their walls were investigated. By means of an electronic and microscopic method ultrastructural features and ways of connection of endothelial cells in walls limf, capillaries [D. A. Zhdanov, V. A. Shakhlamov, were shown 1964; J. R. Casley-Smith, 1964; V. A. Shakhlamov, 1971]; in an experiment ways of penetration of proteic matters and foreign debris to a gleam limf were tracked, capillaries, their place and value in system of microcirculation is defined (V. V. Kupriyanov, 1969; V. V. Kupriyanov, V. I. Kozlov, Ya. L. Karaganov, 1976), and also are studied changes of various links limf, beds in pathology [I. Rusnyak, Fyoldi, the Sabot (M. Foldi, G. Szabo), 1969; D. D. Zerbino, 1973]. Due to the achievements of immunology, and also in connection with progress in studying of tumoral diseases researches on anatomy, topography and histology limf, nodes [V. A. Florensov, were undertaken 1964; Yu. I. Borodin, 1969; Kottye, Terk, Sobin (N. of Cottier, J. Turk, L. Sobin), 1973; M. A. Dolgova, 1974; M. R. Sapin, E. I. Borzyak, 1976; M. R. Sapin, N. A. Yurina, L. E. of the ethynegen. of 1978].

Thanks to achievements lymphologies (see) in a wedge, practice were x-ray methods of a research limf, vessels and limf, nodes at the living person are studied and were widely adopted (see. Limfografiya ) - the accumulated experience is generalized in a number of works, including in monographs of theorists and clinical physicians [M. G. Prives, 1948; B. Ya. Lukyanchenko, 1966; Roksin, Buzhar (T. Roxin, H. Bujar), 1973; Reder (To. Roder), 1974; G. A. Zedgenidze, A. F. Dyb, 1977].

Phylogenesis

For a lancelet and Cyclostoma is available undifferentiated hemolymphatic system. Separation of Hp from circulatory system occurs for the first time at bony fishes, at to-rykh Hp is presented pair superficial and deep longitudinal, and also enteromesenteric limf, by vessels and limf, sine between fins, between a pericardium and branchiate bags and between internals. Amphibians and reptiles have so-called lymph hearts — sokratitelny bodies, in walls to-rykh there are muscular elements. Limf, hearts have an appearance one - or the multichamber bubbles connected as with limf, vessels and sine, and to veins. For a frog is available four limf, hearts, for amphibians having a tail (a triton, a salamander) — 15 steam rooms side limf, hearts and 8 — 10 limf, hearts in scapular, pelvic and other areas. Reptiles along with sine have textures limf, vessels, is available also two back limf, hearts. At birds limf, hearts are available only at a stage of embryonic development. Waterfowl for the first time have limf, nodes (cervical and lumbar), limf, vessels fall into veins in several places. At mammals the structure limf, systems becomes difficult. There are valves in limf, vessels, a large number limf, nodes.

Ontogenesis

At the person limf, vessels develop from a mesenchyma, separately from circulatory system near the forming large veins. There are slit-like spaces limited to mesenchymal cells in the beginning to-rye then are flattened and turn into endothelial. Slit-like spaces connect with each other, forming system of channels, to-rye merge and expand thanks to what are formed limf, bags. On the 6th week of an antenatal life the right and left jugular bags form.

A bit later in subclavial areas bags develop so-called subclavial limf. The chain limf, the bags located along a back body wall at the left gives rise to the main thing limf, to a trunk — to a chest channel, to-ry in an initial stage of the development (on the 9th week) opens in a jugular limf, a bag. Expansion of an initial part of the chest canal — the tank of a chest channel, cisterna ductus thoracici (the lacteal tank, cisterna chyli) is formed of retroperitoneal (mesenteric) bags in lumbar area. A little kaudalny grow from a retroperitoneal bag limf, the vessels providing outflow of a lymph from bodies went. - kish. path, kidneys. Steam rooms ileal limf, bags at the level of bifurcation of a ventral aorta proceed in iliolumbar and ilioinguinal expansions. The last create system limf, vessels of the lower extremities, and also a rectum and crotch.

To the 9th week of an antenatal life main limf, vessels hold position inherent to them. The place of the message subclavial limf, bags with brachiocephalic veins (the mouth of a chest channel and jugular trunk at the left) has valves. Connection jugular limf, a bag with limf, vessels of a neck creates jugular limf, a trunk. In caudal department the chest channel forms the lacteal tank, and it is in turn reported with mesenteric and ilioinguinal trunks (vessels). Further from limf, bags by germination of endothelial outgrowths and their sewerage vessels form limf. Limf, bags at the same time are narrowed and turn in limf, collectors.

Limf, nodes are put on the course limf, vessels, since 3rd month of an antenatal life. In certain places near limf, vessels accumulations of mesenchymal cells appear; an external part of walls limf, a vessel participates in formation of the capsule of a node, and the gleam of a vessel will be transformed to a regional (subkapsulyarny) sine. Intermediate and portal sine limf, a node form later. From the central departments of a mesenchymal rudiment limf, a node the parenchyma limf is formed further. node. Formation of follicles in a parenchyma limf, a node is noted since the beginning of the 5th month of an antenatal life in connection with formation of blood vessels limf. node. Before the birth of the child or soon after the birth there is a differentiation cortical and marrow of nodes. All structural components limf, nodes have age features and in post-natal ontogenesis.

Anatomy

Fig. 1. Scheme of education and confluence of a chest lymphatic channel: 1 — network of lymphatic capillaries; 2 — absorbent vessels; 3 — lymph nodes; 4 — a chest channel; 5 — an upper vena cava; in — a venous corner (the place of merge of internal jugular and subclavial veins); the direction of current of a lymph is specified by shooters.
Fig. 1. Lymphatic system of the person: 1 — lymphatic. vessels of the person; 2 — subsubmaxillary lymph nodes; 3 — submental lymph nodes; 4 — the mouth of a chest channel; 5 — front mediastinal lymph nodes; 6 — axillary lymph nodes; 7 — the superficial absorbent vessels of a hand following on the course of a lateral saphena of a hand; 8 — medial group of superficial absorbent vessels of a hand; 9 — lumbar lymph nodes; 10 — the general ileal lymph nodes; 11 — outside ileal lymph nodes; 12 — superficial inguinal lymph nodes; 13 — medial group of superficial absorbent vessels of a shin; 14 — lateral group of superficial absorbent vessels of a shin; 15 — superficial absorbent vessels of foot; 16 — deep absorbent vessels of foot; 17 — deep absorbent vessels of a shin; 18 — deep absorbent vessels of a hip; 19 — deep absorbent vessels of a palm; 20 — deep inguinal lymph nodes; 21 — internal ileal lymph nodes; 22 — deep absorbent vessels of a forearm; 23 — a chest channel; 24 — superficial elbow lymph nodes; 25 — intercostal lymph nodes; 26 — humeral lymph nodes; 27 — a subclavial trunk; 28 — a jugular trunk; 29 — deep cervical lymph nodes; 30 — deep cervical lymph nodes (a chain of nodes on the course of an eleventh cranial nerve); 31 — a biventral and jugular lymph node; 32 — zaushny lymph nodes; 33 — parotid lymph nodes.
Fig. 2. Formation of absorbent vessels submucosal (deep) and subserous (superficial) stomach of the textures transporting a lymph from limfokapillyarny networks of various layers of body to separate regional lymph nodes (also anatomo-topographical relationship of lymphatic capillaries, vessels and nodes with veins and arteries are shown; the drawing from drugs of polikhromny injections of a lymphatic bed, veins and arteries): 1 — cardial lymph nodes and the absorbent vessels suitable them from a cardial part and the right half of a greater cul-de-sac (the territory of I); 2 — the left pancreatic lymph nodes and the vessels of small curvature suitable them and parts of a body of a stomach (the territory of II), adjacent to it; 3 — right gastric and hepatic lymph nodes and the vessels suitable them from an upper half of walls of the pyloric channel, the gatekeeper and an upper part (bulb) of a duodenum (the territory of III); 4 — pyloric lymph nodes and the vessels suitable them from the lower half of walls of the pyloric channel, the gatekeeper and an upper part (bulb) of a duodenum (the territory of IV); 5 — the right gastroomental lymph nodes and the vessels suitable them from parts of a threshold of the gatekeeper and a caudal part of a body of a stomach (the territory of V), adjacent to big curvature; 6 — the left gastroomental lymph nodes and the vessels suitable them from a cranial part of a body of a stomach, adjacent to big curvature (the territory of VI); 7 — splenic lymph nodes and the vessels suitable them from the left half of a greater cul-de-sac (the territory of VII); 8 — celiac lymph nodes; 9 — the taking-out absorbent vessels of celiac nodes transporting a lymph to lumbar lymph nodes; 10 — network of lymphatic capillaries of a mucous membrane on an otseparovanny rag (the epithelium is removed); 11 — a mucous membrane of a back wall of a stomach; 12 — network of wide limfokapillyar and a deep texture of absorbent vessels and their relationship with veins and arteries in friable connecting fabric of a submucosa; 13 — the absorbent vessels which are taking away a lymph from interfascicular limfokapillyar of a longitudinal layer of a muscular coat; 14 — the absorbent vessels which are taking away a lymph from interfascicular limfokapillyar of a circular layer of a muscular coat; 15 — the absorbent vessels which are taking away a lymph from interfascicular limfokapillyar of slanting muscle bundles; 16 — a subserous (superficial) texture of absorbent vessels; 17 — limforazdet on border between chest and belly parts of a gullet; 18 — the zone limforazdet; 19 — a diaphragm; but — connection of limfokapillyar of a stomach and duodenum; 21 — limfokapillyara and vessels of an upper part (bulb) of a duodenum; 22 — the absorbent vessels of cardial department of a stomach going to back mediastinal lymph nodes.
Fig. 3. Anatomy and topography of ways of step-by-step transportation of a lymph from various parts of a stomach (the stomach is displaced up; the drawing from drugs of polikhromny injections of a lymphatic bed, veins and arteries): 1 — cardial lymph nodes (back); 2 — the left gastric lymph nodes; 3 — the right gastric lymph nodes; 4 — pyloric lymph nodes; 5 — the right gastroomental lymph nodes; 6 — the left gastroomental lymph nodes; 7 — splenic lymph nodes; 8 — celiac lymph nodes; 9 — the taking-out vessels of celiac nodes; 10 — lumbar lymph nodes; 11 — upper mesenteric lymph nodes; 12 — pancreaticoduodenal lymph nodes; 13 — hepatic lymph nodes; 14 — the zone limforazdet.

Limf, system (tsvetn. fig. 1) consists of initial department — networks limf, capillaries (see. Capillaries , Absorbent vessels ), the substances which are located in bodies and carrying out function of a resorption from fabrics; small, supplied with valves, intraorganic limf, the vessels which are taking away a lymph from limf, capillaries; extra organ limf, the vessels which are taking away a lymph from vessels of bodies in limf, the nodes (bringing vessels), and larger limf, the vessels which are taking away a lymph from limf, nodes (the taking-out vessels); lymph nodes (see), located on the course limf, vessels; large limf, vessels — trunks and channels [right and left jugular, subclavial, bronkhosredostenny, lumbar limf, trunks, chest channel (see), right limf, a channel], falling into veins of a neck — a venous corner on the right and at the left (fig. 1). Limf, vessels in nek-ry places merge or fork, forming collaterals, to-rye play a significant role in roundabout current of a lymph in the conditions of norm and pathology.

The so-called private anatomy of Hp, i.e. Hp in each body, each part of a body, has the features.

Fig. 2. The diagrammatic representation of the superficial absorbent vessels of the lower extremity bearing a lymph to regional lymph nodes: 1 — medial, 2 — lateral, 3 — back group of absorbent vessels; 4 — lymph nodes (subnodal and superficial inguinal).

Hp of the lower extremity begins limf, the capillaries forming networks in skin and hypodermic cellulose, fastion, muscles, sinews, capsules of joints, ligaments, a periosteum, walls of vessels and in nerves. Formed of these capillaries limf, vessels (superficial and deep) go to regional limf, nodes of the lower extremity (fig. 2).

The back group superficial limf, reaches the vessels originating in calcaneal area and accompanying a small saphena subnodal limf, nodes, medial group of vessels (from an inner edge of foot and a dorsum of fingers) and lateral (from the outer edge of foot, the III—IV fingers and from an outer surface of a shin) go to superficial inguinal limf, to nodes, being located parallel to large veins of a shin, and then a saphena. Deep limf, vessels are near bottom and back arteries and veins of foot, lobbies and back tibial, femoral blood vessels and reach deep inguinal limf, nodes. Between superficial and deep limf, an anastomosis is available vessels of the lower extremity. In superficial inguinal limf, nodes fall also limf, vessels of external genitals, crotches, a skin zone of an anal orifice, a rump, skin and hypodermic cellulose of infraumbilical area of a front wall of a stomach. Taking out limf, vessels superficial inguinal limf, nodes probodat a superficial (wide) fascia of a hip and fall in deep inguinal limf, the nodes and which are taking out limf, vessels of the last go to outside ileal limf, to the nodes located near the blood vessels of the same name.

Hp of a small pelvis is presented limf, capillaries and vessels various on a structure and on function of the bodies relating to urinogenital system (a bladder, pelvic department of ureters, ovaries, a uterus with uterine tubes, a vagina, a prostate gland, seed bubbles, etc.), and also Hp of a rectum, cellulose, fastion and a peritoneum of a small pelvis. Taking away limf, vessels of ovaries, a bottom and body of the womb, uterine tubes, lying between leaves of a wide ligament of uterus, go to a sidewall of a basin, and then, accompanying blood vessels of ovaries, reach lumbar lifm. the nodes (latero-and preaortalny) located at the beginning of ovarian arteries and near the lower mesenteric artery. From lower parts of a body of the womb, her neck, a vagina limf, vessels, being located near a uterine artery, go to internal and outside ileal, located near the arteries of the same name and veins, and also to sacral limf, nodes lying behind a rectum on a front surface of a sacrum.

Limf, vessels of a bladder, seed bubbles and a small egg go along the arteries and veins supplying them to limf, to the nodes forming a medial chain near outside ileal blood vessels and also to the internal ileal, lying on an outside wall of a small pelvis at the place divisions of an internal ileal artery into branches, and to anal limf, nodes which are about the bottom of a rectum.

From lower parts of a rectum limf, vessels follow to internal ileal limf, to the nodes lying near the lower, average and upper pryamokishechny arteries; in the same nodes (near average and upper pryamokishechny arteries), and also vessels (behind and sideways from a rectum, near lateral sacral arteries) from an ampoule of a rectum fall into sacral nodes limf.

Fig. 3. The diagrammatic representation of an arrangement of lumbar and ileal lymph nodes (according to D. A. Zhdanov): 1 — celiac; 2 — left lateroaortalny; 3 — lower mesenteric; 4 — 9 — lumbar (4 — preaortalny, 5 — retroaortal, 6 — prekavalny, 7 — laterokavalny, 8 — retrocaval, 9 — interaortokavalny); 10 — the general ileal; 11 — outside ileal; 12 — internal ileal.

To the general ileal limf, to nodes (medial, lateral and average chains) all lymph comes from bodies and limf, nodes of a basin and the lower extremities, and their taking-out vessels go to located near a ventral aorta and the lower vena cava lumbar (okoloaortalny) limf, to nodes (fig. 3). Also the lymph from a back abdominal wall, a peritoneum, bodies and numerous limf, the nodes (pristenochny and visceral) located in an abdominal cavity, as a rule, on the course of blood vessels (arteries and veins) comes to lumbar limf, nodes.

Limf, vessels of a stomach fall in left gastric limf, nodes (from the cardia and the right half of the arch, and also from belly department of a gullet), in left and right gastric limf, nodes (from front and back walls of a stomach near its small curvature), into pyloric limf, nodes (from the gatekeeper and a bulb of a duodenum), in right and left gastrostuffing limf, nodes (from front and back walls of a stomach where gastroomental arteries branch) and into pankreatoselezenochny limf, nodes (from the left part of the arch and an adjacent part of big curvature of a stomach). To gastroomental limf, nodes vessels from a big epiploon go also limf. From all groups gastric limf, the nodes located on the course of blood vessels of a stomach from pankreatoselezenochny, in to-rye fall limf, the vessels of a pancreas and spleen which are taking out limf, vessels follow to celiac, in the beginning, and then to lumbar limf, nodes.

Limf, vessels of a duodenum, a head and a body of a pancreas fall in pyloric, pankreatoduodenalny and central mesenteric limf. nodes. From a lean and ileal gut limf, vessels go to upper mesenteric limf, to the nodes lying between two leaves of a peritoneum on the course of branches of an upper mesenteric artery and near the veins of the same name; these nodes form in a mesentery as if three chains. The peripheral chain limf, nodes lies near mesenteric edge of a gut, and also at the level of arterial arcades, average — approximately on the middle between a gut and a root of a mesentery and central — in the field of a root of a mesentery, around mesenteric arteries and veins. From these nodes limf, vessels go to lumbar and celiac limf, to nodes.

Leaving a wall of a large intestine limf, vessels go to ileal and colonic limf, nodes (from a caecum and worm-shaped, a shoot and from adjacent department of an ileal gut), to the right colonic nodes (from the ascending colon), to average colonic nodes (from a cross colon), to the left colonic nodes (from the descending colonic and sigmoid gut) forming chains of nodes near the blood vessels of the same name.

Limf, vessels of a liver, I create - shchiyesya in deep and its superficial departments, about several directions leave. From a lower surface, from portal fissures and from bilious, a bubble, limf, vessels (front group) follow along a hepatic artery and a portal vein to hepatic, pyloric, right gastric and pankreatoduodenalny limf, to nodes, and back group of vessels — along hepatic veins directly to lumbar limf, nodes. Limf, vessels from the phrenic surface of a liver go in the thickness of ligaments of a liver to limf, to the nodes located about the right lower phrenic artery to lumbar (laterokavalny, retrocaval, interaortokavalny) and celiac, and also (pro-butting a diaphragm) to limf, to the nodes of a chest cavity lying on a diaphragm — phrenic, or is slightly higher — intercostal, front mediastinal (pericardiac), periesophagal and right okologrudinny. The vessels forming in the thickness of a diaphragm fall into the same limf, nodes and in lobbies mediastinal limf. To the okologrudinny limf, nodes lying near internal chest blood vessels vessels from the epigastriß limf, nodes lying on a front abdominal wall under a peritoneum and accepting limf, vessels from skin, hypodermic cellulose, muscles, fastion and other bodies of a front abdominal wall go also limf (above a navel).

Fig. 4. The diagrammatic representation of an arrangement of the lumbar lymph nodes accepting a lymph from adrenal glands: 1 — retrocaval, 2 — interaortokavalny, 3 — laterokavalny, 4 — prekavalny, 5 — left lateroaortalny, 6 — lower mesenteric, 7 — celiac, 8 — preaortalny (according to D. A. Zhdanov).

From the right and left kidneys limf, vessels leave area of gate (deep), accompanying the blood vessels forming a renal leg and also from a renal capsule (superficial). Both groups limf, vessels go to regional limf, nodes of kidneys: to lumbar (preaortalny, lateroaortalny) — for a left kidney, to lumbar (laterokavalny, retrocaval, prekavalny, interaortokavalny) — for a right kidney, and also to celiac. To the same limf, nodes vessels from the right and left adrenal glands (fig. 4) go taking away limf; limf, vessels go out through gate of an adrenal gland near an adrenal (central) vein (deep) and of its capsule (superficial).

From taking out limf, vessels lumbar limf, nodes two form (right and left) or bigger quantity lumbar limf, trunks, to-rye, merging with each other at the level of XII of chest — the II lumbar vertebrae, give rise to a chest channel (see).

From limf, the capillaries forming networks in bodies of a chest cavity and its walls the vessels going to limf, to the nodes (visceral and parietal) located near bodies and large vessels (front, back mediastinal) on walls of a chest cavity (intercostal, okologrudinny, phrenic), and also to limf, to nodes of adjacent areas of a body form limf (axillary, cervical).

From a pulmonary parenchyma, walls of bronchial tubes and blood vessels of lungs accompanying them limf, vessels go to gate of a lung, being interrupted on this way in pulmonary and bronchopulmonary limf, nodes. From the right lung limf, vessels follow to lower tracheobronchial, back mediastinal (mezhaortopishchevodny) and front mediastinal limf, to nodes (to prevenozny — ahead from an upper vena cava and its inflows) — from lower and an average share, and also to right upper tracheobronchial limf, to nodes — from an upper share. From the lower share of the left lung limf, vessels follow to lower tracheobronchial, back mediastinal (periesophagal and pozadiperikardialny) to nodes, from an upper share — to left upper tracheobronchial, front mediastinal (predaortokarotidny) limf, to nodes. In the field of gate of a lung leaving its shares limf, vessels on the way to regional limf, nodes prilezhat to share and main to bronchial tubes, pulmonary arteries and veins.

To lobbies mediastinal limf, to nodes vessels of a thymus go limf. In lobbies mediastinal, in lower and right upper tracheobronchial limf, nodes fall limf, vessels of heart. Left collector limf, the vessel of heart forms on a front surface of heart, the right vessel — on back.

Limf, the vessels of a gullet departing from it throughout go to various groups on the level of an arrangement limf, nodes. From belly department of a gullet limf, vessels fall in left gastric and celiac limf, nodes; to the same nodes a part of vessels from the lower and average third of chest department of a gullet goes. Other part limf, vessels from these departments of a gullet accepts the ascending direction and falls in back mediastinal (mezhaortopishchevodny) and even tracheal limf. nodes. In these nodes, and also in lower and upper tracheobronchial, deep cervical (internal jugular) and vessels from cervical department of a gullet fall into back mediastinal (prevertebral) nodes limf. A part limf, vessels from walls of a gullet passes limf, nodes and falls directly into the chest canal that explains bystry emergence of the remote metastasises even at small malignant tumors of a gullet.

From visceral limf. nodes of a chest cavity outflow of a lymph is carried out to limf, to nodes and collector limf, to the vessels located in the field of the basis of a neck. Taking out limf, vessels of lobbies mediastinal limf, nodes (pericardiac, prevenozny — ahead of an upper vena cava and right brachiocephalic) create front mediastinal limf, the trunk, to-ry falls in right subclavial limf, a trunk, right jugular limf, a trunk, into a vein in the field of the right venous corner and (seldom) directly into the right chest canal. Limf, vessels of a horizontal chain (ahead of the left brachiocephalic vein) connect with taking out limf, vessels predaortokarotidny limf, nodes, lying ahead of an aortic arch and the left general carotid artery, and fall in left upper tracheobronchial limf, nodes, left jugular limf, nodes or directly into the chest canal. Between prevenozny limf, nodes and nodes of a horizontal chain there is anastomosis. „the vessels which are taking out limf limf, nodes of a postmediastinum fall in lower tracheobronchial limf, nodes or directly into the chest canal.

Limf, vessels from soft tissues of chest walls (skin, hypodermic cellulose, muscles, a parietal pleura and other bodies) go to the next parietal limf, to nodes of a chest cavity (intercostal, phrenic, okologrudinny), and also to deep (lower) cervical limf, to nodes (supraclavicular) and to axillary nodes. From mammary (chest) gland limf, vessels go to axillary (from a lateral part of gland), to okologrudinny (from a medial part) and to deep (lower) cervical limf, to nodes.

From okologrudinny limf, nodes taking out limf, vessels go to internal jugular limf, to nodes, and also fall in subclavial, in internal jugular limf, a trunk or directly into an arch of a chest channel (at the left).

Regional limf. nodes for limf, vessels of the head — from soft covers of a neurocranium and the person, from an eye-socket, an outside and middle ear, a mucous membrane of a nasal cavity, sialadens, bodies of an oral cavity, etc. are located a chain on border of the head and neck, is preferential under a mandible and behind it, and also in superficial departments of a neck, near outside and front jugular veins. In occipital area, at the place of an attachment of muscles to an occipital bone, nodes are located occipital limf (superficial — on a trapezoid muscle, deep — on a belt muscle of the head). Vessels of skin and other soft tissues of adjacent departments of the head fall into these nodes superficial and deep limf. To the zaushny limf, nodes located near a mastoid pass limf, vessels of an auricle, outside acoustical pass, skin of temporal and parietal areas. From an outside and middle ear, and also from skin of a forehead and temporal area, a root of a nose and a century limf, vessels go to superficial and deep parotid limf, to nodes. Vessels of a parotid sialaden and a mucous membrane of a nasal cavity fall into these nodes also limf.

From soft tissues of front and side departments of the person (a lower eyelid, a cheek, the forefront of a mucous membrane of a nose, an upper lip) limf, vessels, accompanying a facial artery and a vein, go to submaxillary (submandibular, T.) limf, to nodes, being interrupted on the way in buccal limf, nodes (at their existence). Limf, vessels of a chin, an under lip, a neck, a mouth floor come to an end in submental limf, nodes.

Fig. 5. The diagrammatic representation of outflow of a lymph from language in regional lymph nodes (a look on the right side); the direction of outflow of a lymph is specified by shooters): 1 — deep cervical (upper jugular), 2 — submandibular, 3 — a jugular and scapular and hypoglossal node.

From language limf, vessels go to lingual and submaxillary limf, to nodes of the right and left side, to deep (upper) cervical nodes (an internal jugular chain) and to limf, to the nodes lying at the place of crossing of a sinew of a lopatochnopodjyazychny muscle with an internal jugular vein (a node, fig. 5 jugular scapular hypoglossal). In the same limf, nodes, and also in mental (submental, T.) and submaxillary vessels from hypoglossal and submaxillary fall limf (submandibular, T.) sialadens, mucous membrane of gums. From a throat, a thyroid gland limf, vessels go to preguttural (and prethyroid) limf, to the nodes lying under a pretrakhealny plate of a cervical fascia and also to retropharyngeal, tracheal, deep cervical (to internal jugular), to-rye together with tracheobronchial limf, nodes are also regional for a trachea. Nek-rye limf, vessels of a thyroid gland follow to lobbies mediastinal limf, to nodes (a prevenozny chain). From walls of a throat limf, vessels go to retropharyngeal and deep cervical limf, to the nodes located near an internal jugular vein and also to the nodes lying on the course of an eleventh cranial nerve. From a lower part of a throat limf, vessels fall also into tracheal limf. nodes. To retropharyngeal limf, nodes vessels from a mucous membrane of a nasal cavity, an acoustical (eustachian) pipe, a middle ear (a mucous membrane of a drum cavity), the sky and palatine tonsils, nasal and oral parts of a throat go limf.

Limf, vessels of skin, hypodermic cellulose and superficially lying muscles of cervical area fall in superficial cervical limf, the nodes located in the form of a chain near outside and front jugular veins. Taking out limf, vessels of superficial groups limf, nodes of the head and neck probodat a superficial plate of a cervical fascia and go to deep limf, nodes of a neck, adjacent from the different parties to an internal jugular vein on all its extent and located near an outside branch of an eleventh cranial nerve, and also near a superficial branch of a cross artery of a neck.

In limf, the nodes lying near an internal jugular vein fall also taking out limf, vessels preguttural, prethyroid and tracheal limf, nodes. Nek-rye limf, vessels tracheal limf, nodes participate in formation of a jugular trunk or open directly in cervical department of a chest channel. Deep limf, nodes of a neck together with connecting them limf, vessels form internal jugular limf, the way passing into a jugular limf, a trunk to-ry falls into the venous corner formed by internal jugular and subclavial veins on the right and at the left.

Fig. 6. Diagrammatic representation of superficial absorbent vessels of an upper extremity: 1 — medial group, 2 — lateral group, 3 — median absorbent vessels, 4, 5 — regional lymph nodes — axillary (4), and also located in a furrow between deltoid and big chest muscles (5).

Limf, the bed of an upper extremity is presented superficial and deep limf, the vessels originating from capillary networks of skin and hypodermic cellulose, muscles and fastion, joint bags of an upper extremity, and also elbow and axillary limf, by nodes. From skin, hypodermic cellulose and a superficial fascia the vessels forming three groups on the way and accompanying saphenas of an upper extremity (fig. 6) originate superficial limf.

The internal group superficial limf, vessels bears a lymph from area V, IV and elbow edge of the III fingers, an inner edge of a brush and a forearm, outside group limf, vessels — from soft tissues I, II and III fingers, beam edge of a brush and a forearm. The average group limf, vessels originates in skin of a palmar surface of a brush and fingers. These vessels reach axillary limf, nodes, and also limf. the nodes located in a deltogrudny furrow. Deep limf, the vessels of an upper extremity bearing a lymph from muscles, sinews, a periosteum and other deeply located bodies (under a superficial fascia), follow on the course of neurovascular bunches of an upper extremity (elbow, beam, front and back interosseous, humeral) and reach regional limf, nodes (elbow and axillary). Five groups axillary limf, nodes (lateral, chest, infrascapular, central and apical) are located in the pole of the same name. Their taking-out vessels go to apical nodes (subclavial), and from taking out limf, vessels the trunk falling into a venous corner of a neck or into the veins forming it forms subclavial limf: subclavial and internal jugular (or to the chest canal at the left and right limf, a channel on the right).

Anatomy and histology limf, vessels and limf, nodes — see. Grudnoy Canal , Capillaries , Absorbent vessels , Lymph nodes , Adenoid tissue . Private anatomy limf, vessels and limf, nodes — see also in articles devoted to areas of a body (e.g., Person ), to separate bodies (e.g., Stomach ), and also tsvetn. the tab. of fig. 1 — 6; tsvetn. fig. 2 and 3.

Physiology

Hp, being a part of vascular system, carries out along with veins a drainage of fabrics by education lymph (see), and also performs functions, specific to it: barrier limfotsitopoetichesky, immune. Lymphization occurs at the level of roots of Hp — limf, capillaries. In limf, capillaries water, crystalloids and colloid solutions of proteins dissolved in it is soaked up. In them also particles of disintegration of the died cells, bacteria rezorbirutsya, get and extend (metastasize) on limf, to ways tumor cells. In limf, capillaries in lungs get the particles of dust inhaled from the environment, and smoke during the smoking. Besides, in limf, capillaries liquid from serous cavities (peritoneal, pleural, pericardiac) and synovial fluid from cavities of joints is soaked up. Colloid solutions of coarse proteins, particles of suspensions from cavities, foreign debris are soaked up only in limf, capillaries.

The volume of the formed lymph is defined by an amount of water, composition of the chemical substances and protein which are in intersticial space contained in it. Therefore, at increase in filtering a large number of a lymph is formed of circulatory capillaries.

Permeability of circulatory capillaries depends on mechanical, volumetric, nervous and humoral factors and therefore constantly changes; under the influence of these factors also permeability of a wall limf, capillaries changes.

So, at reduction of amount of protein in blood the quantity of the lymph proceeding on a chest channel that is connected with decrease in absorption of liquid in venous departments of capillaries (falling of osmotic pressure of blood) and the increased receipt it in limf, capillaries increases. Total quantity of the protein coming with a lymph to blood is approximately equal to 100 g a day. The structure of circulatory capillaries, condition of the blood proceeding on them, hydrostatic pressure of blood and the proteins which are contained in it influence an amount of water and salts in intersticial space, and function limf, capillaries provides decrease in osmotic pressure of intersticial liquid and the strengthened transition of water and the salts dissolved in it to venous department of circulatory capillaries, i.e. to blood. In blood and in the main substance of fabrics physical are defined by amount of protein. - the chemical factors regulating processes of a metabolism: at a high level of content of proteins in fabrics transition of water, the substances dissolved in it and products of fabric metabolism in blood is at a loss. Thus, process of a lymphopoiesis is of great importance in maintenance of level of a metabolism in fabrics that is especially important in the conditions of pathology.

The lymph formed by absorption of liquid in limf, capillaries flows on limf, to vessels to regional limf, nodes. Transport of a lymph is carried out limf, vessels, limf, by trunks and limf, channels. Having passed through limf, the nodes located on the course limf, vessels, the lymph through a chest channel, the right and left jugular and subclavial trunks, right limf, a channel joins a venous blood. Limf, trunks fall only into the right and left venous corners formed by connection of internal jugular and subclavial veins in a neck. Existence of other places of a confluence limf, vessels in veins — a so-called limfovenozny anastomosis is not proved.

Current of a lymph on limf, to vessels is defined by numerous factors — the constant pressure of the formed lymph, reduction of walls of limfangion, a pulsation of blood vessels, the movement of a body, reduction of smooth muscles in walls of bodies, prisasyvayushchy action of a chest cavity, etc. (see. Absorbent vessels, physiology ). Limf, vessels under the influence of a nervous system are capable to active sokratitelny function, i.e. the size of their gleam can be reversed or the gleam is closed (switching off from a lymph drainage). The tone of a muscular coat limf, vessels, just as activity of blood vessels, is regulated by c. N of page.

Speed of current of a lymph is very changeable; according to D. A. Zhdanov (1952), it depends on quantity of the formed lymph, a structure of a wall limf, vessels, their caliber, the location limf, vessels (organoprinadlezhnost). Total quantity of a lymph, a cut passes per day through a chest channel, fluctuates from 1,5 to 2 l, and through all collectors (a chest channel, right limf, a channel, jugular and subclavial trunks) — to 4 l. Therefore, Hp participates in completion of amount of the circulating blood.

Hp is also depot of liquid (lymph). According to Rusnyak, Fyoldi, the Sabot (1957), quantity of a lymph in Hp — in its vessels and sine limf, nodes — reaches 1 — 2 l.

Limfotsitopoetichesky function of Hp is provided with activity limf, nodes. In them products of lymphocytes are carried out, to-rye come to a lymphatic and circulatory bed. In the peripheral lymph which is formed in capillaries and proceeding on limf, to vessels to their confluence in limf nodes, number of lymphocytes it is less, than in the lymph flowing from limf, nodes. So, in 1 mkl a peripheral lymph only 200 — 300 lymphocytes, and in 1 mkl the central lymph which is in a chest channel and others collector limf, vessels, passed through several limf, nodes — to 2000 lymphocytes contain.

Immune function of Hp is that in limf, nodes the plasmocytes developing antibodies are formed are In - and the T lymphocytes responsible for humoral and cellular immunity (see).

Barrier function of Hp is carried out also limf, nodes, in to-rykh the foreign debris arriving with a lymph, microbes, tumor cells are late, and then are absorbed by the englobing cells. Functions of the mechanical filter are performed by the reticulum from reticular fibers and reticular macrophages which is in a gleam of sine, and functions biol, the filter carry out cells adenoid tissue (see) limf, nodes.

Fig. 7. Microdrugs of superficial network of lymphatic capillaries of a liver of the newborn child and elderly person: 1 — dense network of wide lymphatic capillaries at the newborn and 2 — more rare network of thin lymphatic capillaries at the elderly person; X 32

Age changes of lymphatic system

Calibre limf, capillaries and a very techtonic dance of their network are subject to age changes. Rezorbtsionny surface limf. it is rather more capillaries in bodies of children, than at adults since it is much less a loop of networks, and the caliber of capillaries is rather more (fig. 7). It depends on bigger hydrophily of fabric colloids and bigger dispersion of proteins of plasma at children.

Limf, capillaries at advanced and senile age considerably change in connection with reduction of dispersion of proteins of a blood plasma and decrease in hydrophily of fabric colloids that leads to the known restriction of function limf, capillaries and to their reduction. Further the rezorbtsionny surface of an endothelium limf, capillaries and their rezorbtsionno-drainage function decreases: absorption from fabrics of proteins, water, crystalloids, foreign debris, bacteria, etc. Morphologically it is shown by increase in the size of capillary loops and desolation of a part limf, capillaries. So, on small curvature of a stomach of the person at mature age on 1 mm? a mucous membrane is from 50 to 100 interferruterous limf, sine, at advanced their age of everything 20 — 30, and at long-livers — only 15 — 25. Diameter limf, capillaries changes; they sharply extend, are narrowed so that their gleam disappears. The network limf, capillaries in certain sites of bodies so changes that them happens it is impossible to reveal by method of an injection.

At people of advanced and senile age characteristic protrusions limf, vessels of different size and a form are formed (spherical, pochkovidny, club-shaped, fungoid, etc.); in these parts muscular elements in a vascular wall sometimes are absent, the vascular wall consists only of a connective tissue cover and an endothelium. The specified changes limf, vessels, in detail studied by D. D. Zerbino and D. A. Zhdanov in separate bodies, were called senile varicosity limf, vessels.

At senile age almost twice in comparison with the period of a maturity the quantity axillary limf, nodes decreases; the quantity and inguinal nodes decreases, at the same time their sizes increase, and the form becomes segmented or tape-like.

Change of a structure limf, a node is shown by growth of a connective tissue stroma, the adenoid tissue is replaced with connecting and remains only on the periphery about the capsule. The relation of the area of connecting fabric to the area of a cut of all node at the level of gate makes in 22 — 35 years — 28,5%, and after 61 year — 49,9%; such ratio is characteristic in elbow and visceral limf, nodes. However in visceral nodes (the lower tracheobronchial) against the background of growth of trabeculas and thinning of the capsule abundance of connecting fabric decreases. Also partial substitution of a parenchyma limf, a node fatty tissue is characteristic. Infiltration by fatty tissue of a parenchyma can lead to destruction of the capsule of a node.

With age relatively the amount of cortical substance of a node decreases, and brain — increases. Sharply, though unevenly, in different groups of nodes the number limf, follicles with the light centers decreases; in axillary and inguinal nodes they almost completely disappear in old age, in visceral nodes in a small amount remain even on the ninth decade of life.

In cellular structure limf, nodes the quantity of plasmocytes, macrophages (especially in tracheobronchial nodes) and small lymphocytes increases; the lymphocytopoiesis occurring generally in cortical substance weakens at advanced and senile age. Decrease in a lymphocytopoiesis and delay of current of a lymph lead to thinning pulpy tyazhy and a bast layer limf, nodes, to expansion of intermediate and hilarny sine.

Pathology — see. Grudnoy Canal , Absorbent vessels , Lymph nodes and articles according to names of diseases (e.g., Lymphadenitis , Limfangiit , Elephantiasis etc.).


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M of P. Sapin; V. A. Makarov, E. I. Borzyak (physical.), B. A. Nikityuk (geront.); V. S. Revazov (tsvetn, fig.).

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