纵隔淋巴结分区(解剖及影像学分区)ppt课件

.,纵隔淋巴结,.,纵隔淋巴结解剖,特点：纵隔淋巴结平均数目为64个，大多数位于气管，支气管附近和大血管及食道周围主要是位于气管旁的淋巴结A主要是位于大血管旁的淋巴结主要是位于支气管旁的淋巴结P主要是位于食管周围淋巴结,.,ClassificationofRegionalLymphNodesinJapan,JapanSocietyofClinicalOncology(ed),Kanehara,Tokyo,2002.,.,ClassificationofRegionalLymphNodesinJapan,JapanSocietyofClinicalOncology(ed),Kanehara,Tokyo,2002.,.,ClassificationofRegionalLymphNodesinJapan,JapanSocietyofClinicalOncology(ed),Kanehara,Tokyo,2002.,.,.,.,MountainandDreslerclassificationsystem,SchemaofMountainandDreslerclassificationsystem,1997年,Mountain修订了肺癌胸内淋巴分区系统被美国癌症联合会(theAmericanJointCommitteeonCancer,AJCC)和国际抗癌联盟(theUnionInternationalContreleCancer,UICC)广泛采纳,但其只是根据外科解剖情况定义各组淋巴结界线,并未在横断面上详细描述各组淋巴结的边界。,Chest1997;111;1718-1723,.,MountainandDreslerclassificationsystem,l区最高位纵隔气管前淋巴结2区气管旁淋巴结3区气管前、后或后纵隔（3P）前纵隔（3a）淋巴结4区气管与支气管交界处淋巴结5区主动脉或Botallo淋巴结6区主动脉（升主动脉）旁淋巴结7区隆突下淋巴结,8区隆突下食管旁淋巴结9区下肺韧带淋巴结10区肺门（主支气管）淋巴结11区肺叶间淋巴结12区叶（上、中、下叶）支气管淋巴结13区段支气管淋巴结14区段以下远支气管淋巴结,.,CT-basedDefinitionofThoracicLymphNodeStations:anatlasfromtheuniversityofMichigan,OlvierChapetetal.Int.J.RadiationOncologyBiol.Phys.,Vol.63,No.1,pp.170178,2005,.,下界:到隆突下约3cm。前界:到左右主支气管前壁水平线或右肺动脉后缘;后界:椎体前缘左外界:在奇静脉外缘;右外界:在右主支气管和右中间段支气管内侧,.,.,区（paraeosphagealnodes）,区食管旁淋巴结上界:同7区,是3P向下的延续;下界:沿食管至膈肌食管裂孔,.,.,区（Pulmonaryligamentnodes）,区下肺韧带淋巴结未提,.,区（hilarnodes）区（interlobarnodes）,统称肺门淋巴结。上界为上叶支气管开口层面;下界为下叶段支气管开口以上。,.,头臂静脉弓水平,头臂静脉弓水平,主动脉弓水平,奇静脉弓水平,隆突水平,上叶支气管开口水平,下叶支气管开口水平OR隆突下cm,R,R,R,R,L,L,L,-,左上叶支气管开口水平,.,.,各区肿大淋巴结,.,左上腔静脉,.,主动脉瘤,.,Prospectiveevaluationofcomputedtomographyandmediastinoscopyinmediastinallymphnodestaging,EurRespirJ1997;10:15471551,n=100LNslargerthan1cmwereconsideredCTpositive.,.,MediastinalLymphNodeStagingWithFDG-PETScaninPatientsWithPotentiallyOperableNon-smallCellLungCancer,N=50LNslargerthan1.5cmwereconsideredCTpositive,Chest1997;112;1480-1486,PETblindedtoCTweresignificantlybetter(p=0.004):,.,Meta-AnalysisofPositronEmissionTomographicandComputedTomographicImaginginDetectingMediastinalLymphNodeMetastasesinNon-smallCellLungCancer,AnnThoracSurg2005;79:37581,.,Meta-AnalysisofPositronEmissionTomographicandComputedTomographicImaginginDetectingMediastinalLymphNodeMetastasesinNon-smallCellLungCancer,AnnThoracSurg2005;79:37581,FDGPET,CT,Sensitivityrange,66%100%,overallsensitivity,83%,Specificityrange,81%100%,Overallspecificity,92%,20%81%,44%100%,59%,78%,.,LymphNodeSizeandMetastaticInfiltrationinNon-smallCellLungCancer,Chest2003;123;463-467,Nonmetastaticlymphnodes,Metastaticlymphnodes,n,2486(86%),405(14%),size,7.053.75mm,10.74.7mm(p0.005).,size10mm,1953(79%),170(44%),size10-14mm,404(16%),137(34%),size15mm,130(5%),87(22%),256patients2,891lymphnodes,Conclusion:LymphnodesizeisnotareliableparameterfortheevaluationofmetastaticinvolvementinpatientswithNSCLC.,.,Real-timeendobronchialultrasoundguidedtransbronchialneedleaspirationforsamplingmedi