胃癌淋巴結(jié)轉(zhuǎn)移CT閱片及相關(guān)知識(shí)點(diǎn)陳開波

胃癌淋巴結(jié)轉(zhuǎn)移CT閱片及相關(guān)知識(shí)點(diǎn)匯報(bào)人:陳開波第一頁，共三十二頁。淋巴結(jié)分組CompanyLogoNO.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)1RightparacardialLNs2LeftparacardialLNs3LessercurvatureLNs4LeftgreatercurvatureLNs4sashortgastricarteries4sbleftgastroepiploicartery4d2ndbranchanddistalpartofAGED5SuprapyloricLNs6InfrapyloricLNs第二頁，共三十二頁。CompanyLogoNO.7－胃左動(dòng)脈淋巴結(jié)NO.8a－肝總動(dòng)脈前淋巴結(jié)NO.8p－肝總動(dòng)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(dòng)脈近端淋巴結(jié)NO.11d－脾動(dòng)脈遠(yuǎn)端淋巴結(jié)NO.12a－肝十二指腸韌帶內(nèi)沿肝動(dòng)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(dòng)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)7LNsalongthetrunkleftgastricartery8LNsalongthecommonhepaticartery8aanterosuperior8pposterior9CeliacarteryLNs10SplenichilarLNs11SplenicarteryLNs12HepatoduodenalligamentLNS12aproperhepaticartery12bbileduct12pportalvein13LNsontheposteriorsurfaceofthepancreaticcranialtotheduodenalpapilla14LNsalongthesuperiormesentericvein15LNsalongthemiddlecolicvessels17LNsontheanteriorsurfaceofthepancreaticheadbeneathpancreaticsheath18LNsalongtheinferiorborderofthe第三頁，共三十二頁。CompanyLogoNO.16a1－主動(dòng)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(dòng)周圍脈淋巴結(jié)NO.16b1－左腎靜脈下緣至腸系膜下動(dòng)脈上緣之間腹主動(dòng)脈周圍淋巴結(jié)NO.16b2－腸系膜下動(dòng)脈上緣至腹主動(dòng)脈分叉之間腹主動(dòng)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)16ParaaorticLNs19InfradiaphragmaticLNspredominantlyalongthesubphrenicartery20ParaesophagealLNsinthediaphragmaticesophagealhiatus110ParaesophagealLNsinthelowerthorax111SupradiaphragmaticLNsseparatefromtheesophagus112PosteriormediastinalLNsseparatefromtheesophagusandtheesophagealhiatus第四頁，共三十二頁。CompanyLogoNO.16a1－主動(dòng)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(dòng)周圍脈淋巴結(jié)NO.16b1－左腎靜脈下緣至腸系膜下動(dòng)脈上緣之間腹主動(dòng)脈周圍淋巴結(jié)NO.16b2－腸系膜下動(dòng)脈上緣至腹主動(dòng)脈分叉之間腹主動(dòng)脈周圍淋巴結(jié)16a1diaphragmaticaortichiatus16a2betweentheuppermarginoftheoriginoftheceliacarteryandthelowerborderoftheleftrenalvein16b1betweenthelowerborderoftheleftrenalveinandtheupperborderoftheoriginoftheinferiormesentericartery16b2betweentheupperborderoftheoriginoftheinferiormesentericarteryandtheaorticbifurcation第五頁，共三十二頁。胃癌淋巴結(jié)CT上呈現(xiàn)NO.1CompanyLogo第六頁，共三十二頁。CompanyLogoNO.2第七頁，共三十二頁。CompanyLogoNO.3第八頁，共三十二頁。CompanyLogoNO.4第九頁，共三十二頁。CompanyLogoNO.5第十頁，共三十二頁。CompanyLogoNO.6第十一頁，共三十二頁。CompanyLogoNO.7第十二頁，共三十二頁。CompanyLogoNO.8第十三頁，共三十二頁。CompanyLogoNO.9第十四頁，共三十二頁。CompanyLogoNO.10第十五頁，共三十二頁。CompanyLogoNO.11第十六頁，共三十二頁。CompanyLogoNO.12第十七頁，共三十二頁。CompanyLogoNO.13第十八頁，共三十二頁。CompanyLogoNO.14第十九頁，共三十二頁。CompanyLogoNO.15第二十頁，共三十二頁。CompanyLogoNO.16第二十一頁，共三十二頁。淋巴結(jié)分期CompanyLogo第二十二頁，共三十二頁。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(dòng)脈根部至胃大彎第1支間的淋巴結(jié)）No.6i（幽門下動(dòng)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)）CompanyLogo圖注：RGEV:（rightgastroepiploicvein）胃網(wǎng)膜右靜脈MD:（mesoduodenum）十二指腸系膜ASPDV:（anteriorsuperiorpancreatoduodenalvein）胰十二指腸上前靜脈第二十三頁，共三十二頁。淋巴結(jié)清掃范圍根據(jù)日本JGCA第四版胃癌治療指南CompanyLogo第二十四頁，共三十二頁。淋巴結(jié)清掃范圍aD1oraD1+lymphadenectomyisindicatedforcT1N0tumorsandD2forcN+orcT2-T4tumors.Sincethepre-andintraoperativediagnosesoflymphnodemetastasesremainunreliable,aD2lymphadenectomyshouldbeperformedwhenevernodalinvolvementissuspected.CompanyLogo第二十五頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogo全胃切除術(shù)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.第二十六頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogo遠(yuǎn)端胃切除術(shù)D0:LymphadenectomylessthanD1.D1:No.1,3,4sb,4d,5,6,7D1+:D1+No.8a,9D2:D1+No.8a,9,11p,12a.第二十七頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogo近端胃切除術(shù)D0:LymphadenectomylessthanD1.D1:No.1,2,3a,4sa,4sb,7.D1+:D1+No.8a,9,11pFortumorsinvadingtheesophagus,D1+includesNo.110.第二十八頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogo胃食管交界癌第二十九頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogo美國AJCC第8版胃癌指南區(qū)域淋巴結(jié)概念：遠(yuǎn)處淋巴結(jié)概念：

Locoregionalnodesgenerallyaresuspiciousfortumorinvolvementifroundand/or>10mminshortaxisdiameter.第三十頁，共三十二頁。淋巴結(jié)清掃范圍CompanyLogoNCCN2017.v3胃癌治療指南清掃≥15個(gè)Theperigastriclymphnodestationsalongthelessercurvature(stations1,3,and5)andgreatercurvature(stations2,4,and6)ofthestomacharegroupedtogetherasN1.Thenodesalongtheleftgastricartery(station7),commonhepaticartery(station8),celi