胃癌淋巴結(jié)轉(zhuǎn)移CT閱片及相關(guān)知識(shí)點(diǎn)陳開(kāi)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(kāi)波本文檔共32頁(yè)；當(dāng)前第1頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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本文檔共32頁(yè)；當(dāng)前第2頁(yè)；編輯于星期二\6點(diǎn)5分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本文檔共32頁(yè)；當(dāng)前第3頁(yè)；編輯于星期二\6點(diǎn)5分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本文檔共32頁(yè)；當(dāng)前第4頁(yè)；編輯于星期二\6點(diǎn)5分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本文檔共32頁(yè)；當(dāng)前第5頁(yè)；編輯于星期二\6點(diǎn)5分胃癌淋巴結(jié)CT上呈現(xiàn)NO.1CompanyLogo本文檔共32頁(yè)；當(dāng)前第6頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.2本文檔共32頁(yè)；當(dāng)前第7頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.3本文檔共32頁(yè)；當(dāng)前第8頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.4本文檔共32頁(yè)；當(dāng)前第9頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.5本文檔共32頁(yè)；當(dāng)前第10頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.6本文檔共32頁(yè)；當(dāng)前第11頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.7本文檔共32頁(yè)；當(dāng)前第12頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.8本文檔共32頁(yè)；當(dāng)前第13頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.9本文檔共32頁(yè)；當(dāng)前第14頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.10本文檔共32頁(yè)；當(dāng)前第15頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.11本文檔共32頁(yè)；當(dāng)前第16頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.12本文檔共32頁(yè)；當(dāng)前第17頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.13本文檔共32頁(yè)；當(dāng)前第18頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.14本文檔共32頁(yè)；當(dāng)前第19頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.15本文檔共32頁(yè)；當(dāng)前第20頁(yè)；編輯于星期二\6點(diǎn)5分CompanyLogoNO.16本文檔共32頁(yè)；當(dāng)前第21頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(jié)分期CompanyLogo本文檔共32頁(yè)；當(dāng)前第22頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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本文檔共32頁(yè)；當(dāng)前第23頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(jié)清掃范圍根據(jù)日本JGCA第四版胃癌治療指南CompanyLogo本文檔共32頁(yè)；當(dāng)前第24頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(jié)清掃范圍aD1oraD1+lymphadenectomyisindicatedforcT1N0tumorsandD2forcN+orcT2-T4tumors.Sincethepre-andintraoperativediagnosesoflymphnodemetastasesremainunreliable,aD2lymphadenectomyshouldbeperformedwhenevernodalinvolvementissuspected.CompanyLogo本文檔共32頁(yè)；當(dāng)前第25頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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.本文檔共32頁(yè)；當(dāng)前第26頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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.本文檔共32頁(yè)；當(dāng)前第27頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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.本文檔共32頁(yè)；當(dāng)前第28頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(jié)清掃范圍CompanyLogo胃食管交界癌本文檔共32頁(yè)；當(dāng)前第29頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(jié)清掃范圍CompanyLogo美國(guó)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.本文檔共32頁(yè)；當(dāng)前第30頁(yè)；編輯于星期二\6點(diǎn)5分淋巴結(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),celiaca