胃癌淋巴结转移CT阅片及相关知识点-陈开波

1、胃癌淋巴结转移胃癌淋巴结转移CT阅片及相关知识点阅片及相关知识点汇报人汇报人: 陈开波陈开波淋巴结分组淋巴结分组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1 Right paracardial LNs2 Left paracardial LNs3 Lesser curvature LNs4 Left greater curvature LNs4sa short gastric arteries4sb left gastroepiploic artery4

2、d 2nd branch and distal part of AGED5 Suprapyloric LNs6 Infrapyloric LNsNO.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 L

3、Ns along the trunk left gastric artery8 LNs along the common hepatic artery8a anterosuperior 8p posterior9 Celiac artery LNs10 Splenic hilar LNs11 Splenic artery LNs12 Hepatoduodenal ligament LNS12a proper hepatic artery12b bile duct12p portal vein13 LNs on the posterior surface of the pancreatic cr

4、anial to the duodenal papilla14 LNs along the superior mesenteric vein15 LNs along the middle colic vessels17 LNs on the anterior surface of the pancreatic head beneath pancreatic sheath18 LNs along the inferior border of theNO.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

5、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 LNs19 Infradiaphragmatic LNs predominantly along the subphrenicartery20 Paraesophageal LNs in the diaphragmatic esophageal hiatus110 Paraesophageal LNs in the lower thorax111 Supradiaphra

6、gmatic LNs separate from the esophagus112Posterior mediastinal LNs separate from the esophagus and the esophageal hiatusNO.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 hiatus16a2 between the upper margin of the

7、origin of the celiac artery and the lower border of the left renal vein16b1 between the lower border of the left renal vein and the upper border of the origin of the inferior mesenteric artery16b2 between the upper border of the origin of the inferior mesenteric artery and the aortic bifurcation胃癌淋巴

8、结胃癌淋巴结CT上呈现上呈现v NO.1v NO.2v NO.3v NO.4v NO.5v9、 人的价值，在招收诱惑的一瞬间被决定。人的价值，在招收诱惑的一瞬间被决定。2022-4-282022-4-28Thursday, April 28, 2022v10、低头要有勇气，抬头要有低气。、低头要有勇气，抬头要有低气。2022-4-282022-4-282022-4-284/28/2022 2:30:00 AMv11、人总是珍惜为得到。、人总是珍惜为得到。2022-4-282022-4-282022-4-28Apr-2228-Apr-22v12、人乱于心，不宽余请。、人乱于心，不宽余请。2022

9、-4-282022-4-282022-4-28Thursday, April 28, 2022v13、生气是拿别人做错的事来惩罚自己。、生气是拿别人做错的事来惩罚自己。2022-4-282022-4-282022-4-282022-4-284/28/2022v14、抱最大的希望，作最大的努力。、抱最大的希望，作最大的努力。2022年年4月月28日星期四日星期四2022-4-282022-4-282022-4-28v15、一个人炫耀什么，说明他内心缺少什么。、一个人炫耀什么，说明他内心缺少什么。2022年年4月月2022-4-282022-4-282022-4-284/28/2022v16、业余

10、生活要有意义，不要越轨。、业余生活要有意义，不要越轨。2022-4-282022-4-28April 28, 2022v17、一个人即使已登上顶峰，也仍要自强不息。、一个人即使已登上顶峰，也仍要自强不息。2022-4-282022-4-282022-4-282022-4-28v NO.6v NO.7v NO.8v NO.9v NO.10v NO.11v NO.12v NO.13v NO.14v NO.15v NO.16淋巴结分期淋巴结分期淋巴结分组最新更新淋巴结分组最新更新vJGCA第第5版胃癌治疗指南版胃癌治疗指南v幽门下区域淋巴结亚分类：幽门下区域淋巴结亚分类： No.6a （胃网膜右动脉

11、根部至胃大弯第（胃网膜右动脉根部至胃大弯第1支间的淋巴结）支间的淋巴结） No.6i （幽门下动脉淋巴结）（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（胃网膜右静脉与胰十二指肠上前静脉/ASPDV汇合部的淋巴结）汇合部的淋巴结）图注：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淋巴结清扫范围v 根据日本根据日本JGCA第四版胃癌治疗指南第四版胃癌治疗指南淋

12、巴结清扫范围淋巴结清扫范围v a D1 or a D1+ lymphadenectomy is indicated for cT1N0 tumors and D2 for cN+ or cT2-T4 tumors. vSince the pre- and intraoperative diagnoses of lymph node metastases remain unreliable, a D2 lymphadenectomy should be performed whenever nodal involvement is suspected.淋巴结清扫范围淋巴结清扫范围v 全胃切除术全

13、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.淋巴结清扫范围淋巴结清扫范围v 远端胃切除术远端胃切除术D0: Lymphadenectomy less than D1.D1: No. 1, 3, 4sb, 4d, 5, 6, 7D1+:D1

14、+No. 8a, 9D2: D1+No. 8a, 9, 11p, 12a.淋巴结清扫范围淋巴结清扫范围v 近端胃切除术近端胃切除术D0: Lymphadenectomy less than D1.D1: No. 1, 2, 3a, 4sa, 4sb, 7.D1+:D1+ No. 8a, 9, 11pFor tumors invading the esophagus, D1+includes No.110.淋巴结清扫范围淋巴结清扫范围v 胃食管交界癌胃食管交界癌淋巴结清扫范围淋巴结清扫范围v美国美国AJCC第第8版胃癌指南版胃癌指南区域淋巴结概念：区域淋巴结概念： 远处淋巴结概念：远处淋巴结概念

15、： Locoregional nodes generally are suspicious for tumor involvement if round and/or 10 mm in short axis diameter. 淋巴结清扫范围淋巴结清扫范围v NCCN 2017. v3 胃癌治疗指南胃癌治疗指南v 清扫清扫15个个v The perigastric lymph node stations along the lesser curvature (stations 1, 3, and 5) and greater curvature (stations 2, 4, and 6) o

16、f the stomach are grouped together as N1. v The nodes along the left gastric artery (station 7), common hepatic artery (station 8), celiac artery (station 9), and splenic artery (stations 10 and 11) are grouped together as N2. v More distant nodes, including para aortic (N3 and N4), are regarded as

17、distant metastases. v D0, D1,D2 same as JGCA34v9、 人的价值，在招收诱惑的一瞬间被决定。人的价值，在招收诱惑的一瞬间被决定。2022-4-282022-4-28Thursday, April 28, 2022v10、低头要有勇气，抬头要有低气。、低头要有勇气，抬头要有低气。2022-4-282022-4-282022-4-284/28/2022 2:30:01 AMv11、人总是珍惜为得到。、人总是珍惜为得到。2022-4-282022-4-282022-4-28Apr-2228-Apr-22v12、人乱于心，不宽余请。、人乱于心，不宽余请。2022-4-282022-4-282022-4-28Thursday, April 28, 2022v13、生气是拿别人做错的事来惩罚自己。、生气是拿别人做错的事来惩罚自己。2022-4-282022-4-282022-4-282022-4-284/28/2022v14、抱最大的希望，作最大的努力。、抱最大的希望，作最大的努力。2022年年4