胃癌淋巴结转移CT阅片及相关知识点课件

单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,.,胃癌淋巴结转移,CT,阅片及相关知识点,汇报人,:,陈开波,胃癌淋巴结转移CT阅片及相关知识点汇报人: 陈开波,1,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 LNs,2 Left paracardial LNs,3 Lesser curvature LNs,4 Left greater curvature LNs,4sa short gastric arteries,4sb left gastroepiploic artery,4d 2,nd,branch and distal part of AGED,5 Suprapyloric LNs,6 Infrapyloric LNs,.,淋巴结分组NO.1贲门右淋巴结.,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,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,.,NO.7胃左动脉淋巴结7 LNs along the tr,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,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,.,NO.16a1主动脉裂孔淋巴结.,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,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,.,NO.16a1主动脉裂孔淋巴结.,5,胃癌淋巴结,CT,上呈现,NO.1,.,胃癌淋巴结CT上呈现NO.1.,6,NO.2,.,NO.2.,7,NO.3,.,NO.3.,8,NO.4,.,NO.4.,9,NO.5,.,NO.5.,10,NO.6,.,NO.6.,11,NO.7,.,NO.7.,12,NO.8,.,NO.8.,13,NO.9,.,NO.9.,14,NO.10,.,NO.10.,15,NO.11,.,NO.11.,16,NO.12,.,NO.12.,17,NO.13,.,NO.13.,18,NO.14,.,NO.14.,19,NO.15,.,NO.15.,20,NO.16,.,NO.16.,21,淋巴结分期,.,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:,（,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,.,淋巴结分组最新更新JGCA第5版胃癌治疗指南图注：.,23,淋巴结清扫范围,根据日本,JGCA,第四版胃癌治疗指南,.,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,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.,.,淋巴结清扫范围 a D1 or a D1+ lymphade,25,淋巴结清扫范围,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.,.,淋巴结清扫范围全胃切除术D0: Lymphadenectom,26,淋巴结清扫范围,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.,.,淋巴结清扫范围远端胃切除术D0: Lymphadenecto,27,淋巴结清扫范围,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.,.,淋巴结清扫范围近端胃切除术D0: Lymphadenecto,28,淋巴结清扫范围,胃食管交界癌,.,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：,Locoregional nodes generally are suspicious for tumor involvement if round and/or 10 mm in short axis diameter.,.,淋巴结清扫范围美国AJCC第8版胃癌指南 Locoregio,30,淋巴结清扫范围,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 (station 9), and splenic artery (stations 10 and 11) are grouped together as N2.,More distant nodes, including para aortic (N3 and N4), are regarded as distant metastases.,D0, D1,D2 same as JGCA,.,淋巴结清扫范围NCCN 2017. v3 胃癌治疗指南.,31,Thank You !,Thank You !,32,