胃癌淋巴结转移CT阅片及相关知识点-陈开波

淋巴结分组CompanyLogoNO.1－贲门右淋巴结NO.2－贲门左淋巴结NO.3－胃小弯淋巴结NO.4sa－胃短血管淋巴结NO.4sb－胃网膜左血管淋巴结NO.4d－胃网膜右血管淋巴结NO.5－幽门上淋巴结NO.6－幽门下淋巴结1RightparacardialLNs2LeftparacardialLNs3LessercurvatureLNs4LeftgreatercurvatureLNs4sashortgastricarteries4sbleftgastroepiploicartery4d2ndbranchanddistalpartofAGED5SuprapyloricLNs6InfrapyloricLNs第一页，共31页。CompanyLogoNO.7－胃左动脉淋巴结NO.8a－肝总动脉前淋巴结NO.8p－肝总动脉后淋巴结NO.9－腹腔干淋巴结NO.10－脾门淋巴结NO.11p－脾动脉近端淋巴结NO.11d－脾动脉远端淋巴结NO.12a－肝十二指肠韧带内沿肝动脉淋巴结NO.12b－肝十二指肠韧带内沿胆管淋巴结NO.12p－肝十二指肠韧带内沿门静脉后淋巴结NO.13－胰头后淋巴结NO.14v－肠系膜上静脉淋巴结NO.14a－肠系膜上动脉淋巴结NO.15－结肠中血管淋巴结NO.17－胰头前淋巴结NO.18－胰腺下缘淋巴结7LNsalongthetrunkleftgastricartery8LNsalongthecommonhepaticartery8aanterosuperior8pposterior9CeliacarteryLNs10SplenichilarLNs11SplenicarteryLNs12HepatoduodenalligamentLNS12aproperhepaticartery12bbileduct12pportalvein13LNsontheposteriorsurfaceofthepancreaticcranialtotheduodenalpapilla14LNsalongthesuperiormesentericvein15LNsalongthemiddlecolicvessels17LNsontheanteriorsurfaceofthepancreaticheadbeneathpancreaticsheath18LNsalongtheinferiorborderofthe第二页，共31页。CompanyLogoNO.16a1－主动脉裂孔淋巴结NO.16a2－腹腔干上缘至左肾静脉下缘之间腹主动周围脉淋巴结NO.16b1－左肾静脉下缘至肠系膜下动脉上缘之间腹主动脉周围淋巴结NO.16b2－肠系膜下动脉上缘至腹主动脉分叉之间腹主动脉周围淋巴结NO.19－膈下淋巴结NO.20－膈肌食管裂孔淋巴结NO.110－下胸部食管旁淋巴结NO.111－膈上淋巴结NO.112－中纵膈后淋巴结16ParaaorticLNs19InfradiaphragmaticLNspredominantlyalongthesubphrenicartery20ParaesophagealLNsinthediaphragmaticesophagealhiatus110ParaesophagealLNsinthelowerthorax111SupradiaphragmaticLNsseparatefromtheesophagus112PosteriormediastinalLNsseparatefromtheesophagusandtheesophagealhiatus第三页，共31页。CompanyLogoNO.16a1－主动脉裂孔淋巴结NO.16a2－腹腔干上缘至左肾静脉下缘之间腹主动周围脉淋巴结NO.16b1－左肾静脉下缘至肠系膜下动脉上缘之间腹主动脉周围淋巴结NO.16b2－肠系膜下动脉上缘至腹主动脉分叉之间腹主动脉周围淋巴结16a1diaphragmaticaortichiatus16a2betweentheuppermarginoftheoriginoftheceliacarteryandthelowerborderoftheleftrenalvein16b1betweenthelowerborderoftheleftrenalveinandtheupperborderoftheoriginoftheinferiormesentericartery16b2betweentheupperborderoftheoriginoftheinferiormesentericarteryandtheaorticbifurcation第四页，共31页。胃癌淋巴结CT上呈现NO.1CompanyLogo第五页，共31页。CompanyLogoNO.2第六页，共31页。CompanyLogoNO.3第七页，共31页。CompanyLogoNO.4第八页，共31页。CompanyLogoNO.5第九页，共31页。CompanyLogoNO.6第十页，共31页。CompanyLogoNO.7第十一页，共31页。CompanyLogoNO.8第十二页，共31页。CompanyLogoNO.9第十三页，共31页。CompanyLogoNO.10第十四页，共31页。CompanyLogoNO.11第十五页，共31页。CompanyLogoNO.12第十六页，共31页。CompanyLogoNO.13第十七页，共31页。CompanyLogoNO.14第十八页，共31页。CompanyLogoNO.15第十九页，共31页。CompanyLogoNO.16第二十页，共31页。淋巴结分期CompanyLogo第二十一页，共31页。淋巴结分组最新更新JGCA第5版胃癌治疗指南幽门下区域淋巴结亚分类：No.6a（胃网膜右动脉根部至胃大弯第1支间的淋巴结）No.6i（幽门下动脉淋巴结）No.6v（胃网膜右静脉与胰十二指肠上前静脉/ASPDV汇合部的淋巴结）CompanyLogo图注：RGEV:（rightgastroepiploicvein）胃网膜右静脉MD:（mesoduodenum）十二指肠系膜ASPDV:（anteriorsuperiorpancreatoduodenalvein）胰十二指肠上前静脉第二十二页，共31页。淋巴结清扫范围根据日本JGCA第四版胃癌治疗指南CompanyLogo第二十三页，共31页。淋巴结清扫范围aD1oraD1+lymphadenectomyisindicatedforcT1N0tumorsandD2forcN+orcT2-T4tumors.Sincethepre-andintraoperativediagnosesoflymphnodemetastasesremainunreliable,aD2lymphadenectomyshouldbeperformedwhenevernodalinvolvementissuspected.CompanyLogo第二十四页，共31页。淋巴结清扫范围CompanyLogo全胃切除术D0:LymphadenectomylessthanD1.D1:Nos.1–7.D1＋:D1+No.8a,9,11p.D2:D1+No.8a,9,10,11p,11d,12a.Fortumorsinvadingtheesophagus,D1+includes:No.110,D2includesNo.19,20,110and111.第二十五页，共31页。淋巴结清扫范围CompanyLogo远端胃切除术D0:LymphadenectomylessthanD1.D1:No.1,3,4sb,4d,5,6,7D1+:D1+No.8a,9D2:D1+No.8a,9,11p,12a.第二十六页，共31页。淋巴结清扫范围CompanyLogo近端胃切除术D0:LymphadenectomylessthanD1.D1:No.1,2,3a,4sa,4sb,7.D1+:D1+No.8a,9,11pFortumorsinvadingtheesophagus,D1+includesNo.110.第二十七页，共31页。淋巴结清扫范围CompanyLogo胃食管交界癌第二十八页，共31页。淋巴结清扫范围CompanyLogo美国AJCC第8版胃癌指南区域淋巴结概念：远处淋巴结概念：Locoregionalnodesgenerallyaresuspiciousfortumorinvolvementifroundand/or>10mminshortaxisdiameter.第二十九页，共31页。淋巴结清扫范围CompanyLogoNCCN2017.v3胃癌治疗指南清扫≥15个Theperigastriclymphnodestationsalongthelessercurvature(stations1,3,and5)andgreatercurvature(stations2,4,and6)ofthestomacharegroupedtogetherasN1.Thenodesalongtheleftgastricartery(station7),commonhepaticartery(station8),celiacartery(station9),andsplenicartery(stations10and11)aregroupedtogetherasN2.Moredistantnodes,includingparaaortic(N3andN4),areregardedasdistantmetastases.D0,D1,D2sameasJGCA第三十页，共31页。ThankYou!第三十一页，共31页。CompanyLOGO