胃癌淋巴结转移CT阅片及相关知识点-陈开波PPT课件

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,.,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1RightparacardialLNs2LeftparacardialLNs3LessercurvatureLNs4LeftgreatercurvatureLNs4sashortgastricarteries4sbleftgastroepiploicartery4d2ndbranchanddistalpartofAGED5SuprapyloricLNs6InfrapyloricLNs,2,.,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,7LNsalongthetrunkleftgastricartery8LNsalongthecommonhepaticartery8aanterosuperior8pposterior9CeliacarteryLNs10SplenichilarLNs11SplenicarteryLNs12HepatoduodenalligamentLNS12aproperhepaticartery12bbileduct12pportalvein13LNsontheposteriorsurfaceofthepancreaticcranialtotheduodenalpapilla14LNsalongthesuperiormesentericvein15LNsalongthemiddlecolicvessels17LNsontheanteriorsurfaceofthepancreaticheadbeneathpancreaticsheath18LNsalongtheinferiorborderofthe,3,.,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16ParaaorticLNs19InfradiaphragmaticLNspredominantlyalongthesubphrenicartery20ParaesophagealLNsinthediaphragmaticesophagealhiatus110ParaesophagealLNsinthelowerthorax111SupradiaphragmaticLNsseparatefromtheesophagus112PosteriormediastinalLNsseparatefromtheesophagusandtheesophagealhiatus,4,.,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16a1diaphragmaticaortichiatus16a2betweentheuppermarginoftheoriginoftheceliacarteryandthelowerborderoftheleftrenalvein16b1betweenthelowerborderoftheleftrenalveinandtheupperborderoftheoriginoftheinferiormesentericartery16b2betweentheupperborderoftheoriginoftheinferiormesentericarteryandtheaorticbifurcation,5,胃癌淋巴结CT上呈现,NO.1,.,6,.,NO.2,7,.,NO.3,8,.,NO.4,9,.,NO.5,10,.,NO.6,11,.,NO.7,12,.,NO.8,13,.,NO.9,14,.,NO.10,15,.,NO.11,16,.,NO.12,17,.,NO.13,18,.,NO.14,19,.,NO.15,20,.,NO.16,21,淋巴结分期,.,22,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）,.,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,23,淋巴结清扫范围,根据日本JGCA第四版胃癌治疗指南,.,24,淋巴结清扫范围,aD1oraD1+lymphadenectomyisindicatedforcT1N0tumorsandD2forcN+orcT2-T4tumors.Sincethepre-andintraoperativediagnosesoflymphnodemetastasesremainunreliable,aD2lymphadenectomyshouldbeperformedwhenevernodalinvolvementissuspected.,.,25,淋巴结清扫范围,.,全胃切除术,D0:LymphadenectomylessthanD1.D1:Nos.17.D1:D1+No.8a,9,11p.D2:D1+No.8a,9,10,11p,11d,12a.Fortumorsinvadingtheesophagus,D1+includes:No.110,D2includesNo.19,20,110and111.,26,淋巴结清扫范围,.,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.,27,淋巴结清扫范围,.,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.,28,淋巴结清扫范围,.,胃食管交界癌,29,淋巴结清扫范围,.,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/or10mminshortaxisdiameter.,30,淋巴结清扫范围,.,NCCN2017.v3胃癌治疗指南清扫15个Theperigastriclymphnodestationsalongthelessercurvature(stations1,3,and5)andgreatercurvature(stations2,4,and6)ofthestomacharegroupedtogetherasN1.Thenodesalongtheleftgastricartery(station7),commonhepaticartery(station8),celiacar