胃癌淋巴結(jié)轉(zhuǎn)移ct閱片及相關(guān)知識點

1、胃癌淋巴結(jié)轉(zhuǎn)移CT閱片及相關(guān)知識點,匯報人: 陳開波,淋巴結(jié)分組,Company Logo,NO.1－賁門右淋巴結(jié)NO.2－賁門左淋巴結(jié)NO.3－胃小彎淋巴結(jié)NO.4sa－胃短血管淋巴結(jié)NO.4sb－胃網(wǎng)膜左血管淋巴結(jié)NO.4d－胃網(wǎng)膜右血管淋巴結(jié)NO.5－幽門上淋巴結(jié)NO.6－幽門下淋巴結(jié)1 Right paracardial LNs2 Left paracardial LNs3 Lesser curvature

2、LNs4 Left greater curvature LNs4sa short gastric arteries4sb left gastroepiploic artery4d 2nd branch and distal part of AGED5 Suprapyloric LNs6 Infrapyloric LNs,,Company Logo,NO.7－胃左動脈淋巴結(jié)NO.8a－肝總動脈前淋巴結(jié)NO.8p－肝總動

3、脈后淋巴結(jié)NO.9－腹腔干淋巴結(jié)NO.10－脾門淋巴結(jié)NO.11p－脾動脈近端淋巴結(jié)NO.11d－脾動脈遠端淋巴結(jié)NO.12a－肝十二指腸韌帶內(nèi)沿肝動脈淋巴結(jié)NO.12b－肝十二指腸韌帶內(nèi)沿膽管淋巴結(jié)NO.12p－肝十二指腸韌帶內(nèi)沿門靜脈后淋巴結(jié)NO.13－胰頭后淋巴結(jié)NO.14v－腸系膜上靜脈淋巴結(jié)NO.14a－腸系膜上動脈淋巴結(jié)NO.15－結(jié)腸中血管淋巴結(jié)NO.17－胰頭前淋巴結(jié)NO.18－胰腺下緣淋巴結(jié),

4、7 LNs along the trunk left gastric artery8 LNs along the common hepatic artery8a anterosuperior 8p posterior9 Celiac artery LNs10 Splenic hilar LNs11 Splenic artery LNs12 Hepatoduodenal ligament LNS12a proper hepa

5、tic artery12b bile duct12p portal vein13 LNs on the posterior surface of the pancreatic cranial to the duodenal papilla14 LNs along the superior mesenteric vein15 LNs along the middle colic vessels17 LNs on the ant

6、erior surface of the pancreatic head beneath pancreatic sheath18 LNs along the inferior border of the,,Company Logo,NO.16a1－主動脈裂孔淋巴結(jié)NO.16a2－腹腔干上緣至左腎靜脈下緣之間腹主動周圍脈淋巴結(jié)NO.16b1－左腎靜脈下緣至腸系膜下動脈上緣之間腹主動脈周圍淋巴結(jié)NO.16b2－腸系膜下動脈上緣至腹主

7、動脈分叉之間腹主動脈周圍淋巴結(jié)NO.19－膈下淋巴結(jié)NO.20－膈肌食管裂孔淋巴結(jié)NO.110－下胸部食管旁淋巴結(jié)NO.111－膈上淋巴結(jié)NO.112－中縱膈后淋巴結(jié)16 Paraaortic LNs19 Infradiaphragmatic LNs predominantly along the subphrenicartery20 Paraesophageal LNs in the diaphragmatic eso

8、phageal hiatus110 Paraesophageal LNs in the lower thorax111 Supradiaphragmatic LNs separate from the esophagus112Posterior mediastinal LNs separate from the esophagus and the esophageal hiatus,,Company Logo,NO.16a1－主動

9、脈裂孔淋巴結(jié)NO.16a2－腹腔干上緣至左腎靜脈下緣之間腹主動周圍脈淋巴結(jié)NO.16b1－左腎靜脈下緣至腸系膜下動脈上緣之間腹主動脈周圍淋巴結(jié)NO.16b2－腸系膜下動脈上緣至腹主動脈分叉之間腹主動脈周圍淋巴結(jié)16a1 diaphragmatic aortic hiatus16a2 between the upper margin of the origin of the celiac artery and the lowe

10、r border of the left renal vein16b1 between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery16b2 between the upper border of the origin of the inferior mesent

11、eric artery and the aortic bifurcation,胃癌淋巴結(jié)CT上呈現(xiàn),NO.1,Company Logo,,Company Logo,NO.2,,Company Logo,NO.3,,Company Logo,NO.4,,Company Logo,NO.5,,Company Logo,NO.6,,Company Logo,NO.7,,Company Logo,NO.8,,Company Logo,NO.9,

12、,Company Logo,NO.10,,Company Logo,NO.11,,Company Logo,NO.12,,,Company Logo,NO.13,,Company Logo,NO.14,,,Company Logo,NO.15,,,Company Logo,NO.16,淋巴結(jié)分期,Company Logo,淋巴結(jié)分組最新更新,JGCA第5版胃癌治療指南幽門下區(qū)域淋巴結(jié)亞分類：No.6a （胃網(wǎng)膜右動脈根部至胃大彎第1

13、支間的淋巴結(jié)）No.6i （幽門下動脈淋巴結(jié)）No.6v （胃網(wǎng)膜右靜脈與胰十二指腸上前靜脈/ASPDV匯合部的淋巴結(jié)）,Company Logo,圖注：RGEV: （right gastroepiploic vein）胃網(wǎng)膜右靜脈MD: （mesoduodenum）十二指腸系膜ASPDV: （anterior superior pancreatoduodenal vein）胰十二指腸上前靜脈,淋巴結(jié)清掃范圍,根據(jù)日本JGCA

14、第四版胃癌治療指南,Company Logo,,淋巴結(jié)清掃范圍,a D1 or a D1+ lymphadenectomy is indicated for cT1N0 tumors and D2 for cN+ or cT2-T4 tumors. Since the pre- and intraoperative diagnoses of lymph node metastases remain unreliable, a D2 l

15、ymphadenectomy should be performed whenever nodal involvement is suspected.,Company Logo,淋巴結(jié)清掃范圍,Company Logo,全胃切除術(shù),D0: Lymphadenectomy less than D1.D1: Nos. 1–7.D1＋:D1 + No. 8a, 9, 11p.D2: D1 + No. 8a, 9, 10, 11p, 11

16、d, 12a.For tumors invading the esophagus, D1+ includes:No. 110, D2 includes No. 19, 20, 110 and 111.,淋巴結(jié)清掃范圍,Company Logo,遠端胃切除術(shù),D0: Lymphadenectomy less than D1.D1: No. 1, 3, 4sb, 4d, 5, 6, 7D1+:D1+No. 8a, 9D2: D1+

17、No. 8a, 9, 11p, 12a.,淋巴結(jié)清掃范圍,Company Logo,近端胃切除術(shù),D0: Lymphadenectomy less than D1.D1: No. 1, 2, 3a, 4sa, 4sb, 7.D1+:D1+ No. 8a, 9, 11pFor tumors invading the esophagus, D1+includes No.110.,淋巴結(jié)清掃范圍,Company Logo,胃食管交界癌

18、,淋巴結(jié)清掃范圍,Company Logo,美國AJCC第8版胃癌指南區(qū)域淋巴結(jié)概念： 遠處淋巴結(jié)概念：,Locoregional nodes generally are suspicious for tumor involvement if round and/or >10 mm in short axis diameter.,淋巴結(jié)清掃范圍,Company Logo,N

19、CCN 2017. v3 胃癌治療指南清掃≥15個The perigastric lymph node stations along the lesser curvature (stations 1, 3, and 5) and greater curvature (stations 2, 4, and 6) of the stomach are grouped together as N1. The nodes along th

20、e left gastric artery (station 7), common hepatic artery (station 8), celiac artery (station 9), and splenic artery (stations 10 and 11) are grouped together as N2. More distant nodes, including para aortic (N3 and N4),