胃癌淋巴結轉移CT閱片及相關知識點

胃癌淋巴結轉移CT閱片及相關知識點匯報人:陳開波NO.1－賁門右淋巴結NO.2－賁門左淋巴結NO.3－胃小彎淋巴結NO.4sa－胃短血管淋巴結NO.4sb－胃網膜左血管淋巴結NO.4d－胃網膜右血管淋巴結NO.5－幽門上淋巴結NO.6－幽門下淋巴結1RightparacardialLNs2LeftparacardialLNs3LessercurvatureLNs4LeftgreatercurvatureLNs4sashortgastricarteries4sbleftgastroepiploicartery4d2ndbranchanddistalpartofAGED5SuprapyloricLNs6InfrapyloricLNsNO.7－胃左動脈淋巴結NO.8a－肝總動脈前淋巴結NO.8p－肝總動脈后淋巴結NO.9－腹腔干淋巴結NO.10－脾門淋巴結NO.11p－脾動脈近端淋巴結NO.11d－脾動脈遠端淋巴結NO.12a－肝十二指腸韌帶內沿肝動脈淋巴結NO.12b－肝十二指腸韌帶內沿膽管淋巴結NO.12p－肝十二指腸韌帶內沿門靜脈后淋巴結NO.13－胰頭后淋巴結NO.14v－腸系膜上靜脈淋巴結NO.14a－腸系膜上動脈淋巴結NO.15－結腸中血管淋巴結NO.17－胰頭前淋巴結NO.18－胰腺下緣淋巴結7LNsalongthetrunkleftgastricartery8LNsalongthecommonhepaticartery8aanterosuperior8pposterior9CeliacarteryLNs10SplenichilarLNs11SplenicarteryLNs12HepatoduodenalligamentLNS12aproperhepaticartery12bbileduct12pportalvein13LNsontheposteriorsurfaceofthepancreaticcranialtotheduodenalpapilla14LNsalongthesuperiormesentericvein15LNsalongthemiddlecolicvessels17LNsontheanteriorsurfaceofthepancreaticheadbeneathpancreaticsheath18LNsalongtheinferiorborderoftheNO.16a1－主動脈裂孔淋巴結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NO.19－膈下淋巴結NO.20－膈肌食管裂孔淋巴結NO.110－下胸部食管旁淋巴結NO.111－膈上淋巴結NO.112－中縱膈后淋巴結16ParaaorticLNs19InfradiaphragmaticLNspredominantlyalongthesubphrenicartery20ParaesophagealLNsinthediaphragmaticesophagealhiatus110ParaesophagealLNsinthelowerthorax111SupradiaphragmaticLNsseparatefromtheesophagus112PosteriormediastinalLNsseparatefromtheesophagusandtheesophagealhiatusNO.16a1－主動脈裂孔淋巴結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16a1diaphragmaticaortichiatus16a2betweentheuppermarginoftheoriginoftheceliacarteryandthelowerborderoftheleftrenalvein16b1betweenthelowerborderoftheleftrenalveinandtheupperborderoftheoriginoftheinferiormesentericartery16b2betweentheupperborderoftheoriginoftheinferiormesentericarteryandtheaorticbifurcationNO.1NO.2NO.3NO.4NO.5NO.6NO.7NO.8NO.9NO.10NO.11NO.12NO.13NO.14NO.15NO.16JGCA第5版胃癌治療指南幽門下區(qū)域淋巴結亞分類：No.6a（胃網膜右動脈根部至胃大彎第1支間的淋巴結）No.6i（幽門下動脈淋巴結）No.6v（胃網膜右靜脈與胰十二指腸上前靜脈/ASPDV匯合部的淋巴結）圖注：RGEV:（rightgastroepiploicvein）胃網膜右靜脈MD:（mesoduodenum）十二指腸系膜ASPDV:（anteriorsuperiorpancreatoduodenalvein）胰十二指腸上前靜脈根據(jù)日本JGCA第四版胃癌治療指南淋巴結清掃范圍aD1oraD1+lymphadenectomyisindicatedforcT1N0tumorsandD2forcN+orcT2-T4tumors.01Sincethepre-andintraoperativediagnosesoflymphnodemetastasesremainunreliable,aD2lymphadenectomyshouldbeperformedwhenevernodalinvolvementissuspected.02D0:LymphadenectomylessthanD1.D1＋:D1+No.8a,9,11p.Fortumorsinvadingtheesophagus,D1+includes:D1:Nos.1–7.D2:D1+No.8a,9,10,11p,11d,12a.No.110,D2includesNo.19,20,110and111.全胃切除術遠端胃切除術D0:LymphadenectomylessthanD1.D1+:D1+No.8a,9,11pD1:No.1,2,3a,4sa,4sb,7.Fortumorsinvadingtheesophagus,D1+includesNo.110.近端胃切除術胃食管交界癌美國AJCC第8版胃癌指南區(qū)域淋巴結概念：遠處淋巴結概念：Locoregionalnodesgenerallyaresuspiciousfortumorinvolvementifroundand/or>10mminshortaxisdiameter.淋巴結清掃范圍NCCN2017.v3胃癌治療指南Theperigastriclymphnodestationsalongthelessercurvature(stations1,3,and5)andgreatercurvature(stations2,4,and6)ofthestomacharegroupedtogetherasN1.Moredistantnodes,includingparaaortic(N3andN4),areregardedasdistantmetastases.清掃≥15個Thenodesalongthelef