胃癌淋巴结转移CT阅片及相关知识点

胃癌淋巴结转移CT阅片及相关知识点汇报人:陈开波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1RightparacardialLNs2LeftparacardialLNs3LessercurvatureLNs4LeftgreatercurvatureLNs4sashortgastricarteries4sbleftgastroepiploicartery4d2ndbranchanddistalpartofAGED5SuprapyloricLNs6InfrapyloricLNsNO.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7LNsalongthetrunkleftgastricartery8LNsalongthecommonhepaticartery8aanterosuperior8pposterior9CeliacarteryLNs10SplenichilarLNs11SplenicarteryLNs12HepatoduodenalligamentLNS12aproperhepaticartery12bbileduct12pportalvein13LNsontheposteriorsurfaceofthepancreaticcranialtotheduodenalpapilla14LNsalongthesuperiormesentericvein15LNsalongthemiddlecolicvessels17LNsontheanteriorsurfaceofthepancreaticheadbeneathpancreaticsheath18LNsalongtheinferiorborderoftheNO.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16ParaaorticLNs19InfradiaphragmaticLNspredominantlyalongthesubphrenicartery20ParaesophagealLNsinthediaphragmaticesophagealhiatus110ParaesophagealLNsinthelowerthorax111SupradiaphragmaticLNsseparatefromtheesophagus112PosteriormediastinalLNsseparatefromtheesophagusandtheesophagealhiatusNO.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16a1diaphragmaticaortichiatus16a2betweentheuppermarginoftheoriginoftheceliacarteryandthelowerborderoftheleftrenalvein16b1betweenthelowerborderoftheleftrenalveinandtheupperborderoftheoriginoftheinferiormesentericartery16b2betweentheupperborderoftheoriginoftheinferiormesentericarteryandtheaorticbifurcationNO.1NO.2NO.3NO.4NO.5NO.6NO.7NO.8NO.9NO.10NO.11NO.12NO.13NO.14NO.15NO.16JGCA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根据日本JGCA第四版胃癌治疗指南淋巴结清扫范围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.全胃切除术远端胃切除术D0:LymphadenectomylessthanD1.D1+:D1+No.8a,9,11pD1:No.1,2,3a,4sa,4sb,7.Fortumorsinvadingtheesophagus,D1+includesNo.110.近端胃切除术胃食管交界癌美国AJCC第8版胃癌指南区域淋巴结概念：远处淋巴结概念：Locoregionalnodesgenerallyaresuspiciousfortumorinvolvementifroundand/or>10mminshortaxisdiameter.淋巴结清扫范围NCCN2017.v3胃癌治疗指南Theperigastriclymphnodestationsalongthelessercurvature(stations1,3,and5)andgreatercurvature(stations2,4,and6)ofthestomacharegroupedtogetherasN1.Moredistantnodes,includingparaaortic(N3andN4),areregardedasdistantmetastases.清扫≥15个Thenodesalongthelef