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胃癌淋巴结转移CT阅片及相关知识点,汇报人: 陈开波,淋巴结分组,Company Logo,NO.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 1 Right paracardial LNs 2 Left paracardial LNs 3 Lesser curvature LNs 4 Left greater curvature LNs 4sa short gastric arteries 4sb left gastroepiploic artery 4d 2nd branch and distal part of AGED 5 Suprapyloric LNs 6 Infrapyloric LNs,Company Logo,NO.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,7 LNs along the trunk left gastric artery 8 LNs along the common hepatic artery 8a anterosuperior 8p posterior 9 Celiac artery LNs 10 Splenic hilar LNs 11 Splenic artery LNs 12 Hepatoduodenal ligament LNS 12a proper hepatic artery 12b bile duct 12p portal vein 13 LNs on the posterior surface of the pancreatic cranial to the duodenal papilla 14 LNs along the superior mesenteric vein 15 LNs along the middle colic vessels 17 LNs on the anterior surface of the pancreatic head beneath pancreatic sheath 18 LNs along the inferior border of the,Company Logo,NO.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 16 Paraaortic LNs 19 Infradiaphragmatic LNs predominantly along the subphrenicartery 20 Paraesophageal LNs in the diaphragmatic esophageal hiatus 110 Paraesophageal LNs in the lower thorax 111 Supradiaphragmatic LNs separate from the esophagus 112Posterior mediastinal LNs separate from the esophagus and the esophageal hiatus,Company Logo,NO.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 16a1 diaphragmatic aortic hiatus 16a2 between the upper margin of the origin of the celiac artery and the lower border of the left renal vein 16b1 between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery 16b2 between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation,胃癌淋巴结CT上呈现,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,Company Logo,NO.10,Company Logo,NO.11,2019/8/25,17,可编辑,Company Logo,NO.12,Company Logo,NO.13,Company Logo,NO.14,Company Logo,NO.15,Company Logo,NO.16,淋巴结分期,Company Logo,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),Company Logo,图注: RGEV: (right gastroepiploic vein)胃网膜右静脉 MD: (mesoduodenum)十二指肠系膜 ASPDV: (anterior superior pancreatoduodenal vein)胰十二指肠上前静脉,淋巴结清扫范围,根据日本JGCA第四版胃癌治疗指南,Company Logo,淋巴结清扫范围,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 lymphadenectomy should be performed whenever nodal involvement is suspected.,Company Logo,淋巴结清扫范围,Company Logo,全胃切除术,D0: Lymphadenectomy less than D1. D1: Nos. 17. D1:D1 + No. 8a, 9, 11p. D2: D1 + No. 8a, 9, 10, 11p, 11d, 12a. For tumors invading the esophagus, D1+ includes: No. 110, D2 includes No. 19, 20, 110 and 111.,淋巴结清扫范围,Company Logo,远端胃切除术,D0: Lymphadenectomy less than D1. D1: No. 1, 3, 4sb, 4d, 5, 6, 7 D1+:D1+No. 8a, 9 D2: D1+No. 8a, 9, 11p, 12a.,淋巴结清扫范围,Company Logo,近端胃切除术,D0: Lymphadenectomy less than D1. D1: No. 1, 2, 3a, 4sa, 4sb, 7. D1+:D1+ No. 8a, 9, 11p For tumors invading the esophagus, D1+includes No. 110.,淋巴结清扫范围,Company Logo,胃食管交界癌,淋巴结清扫范围,Company Logo,美国AJCC第8版胃癌指南 区域淋巴结概念: 远处淋巴结概念:,Locoregional nodes generally are suspicious for tumor involvement if round and/or 10 mm in short axis diameter.,淋巴结清扫范围,Company Logo,NCCN 2017. v3 胃癌治疗指南 清扫15个 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 the left gastric artery (station 7), common hepatic artery (station 8), celiac artery (sta
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