1、胃癌淋巴结转移CT阅片及相关知识点-陈开波2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 artery4d 2nd branch and distal
2、part of AGED5 Suprapyloric LNs6 Infrapyloric LNs3NO.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
3、 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 cranial to the duodenal p
4、apilla14 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 the4NO.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
5、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 Supradiaphragmatic LNs separate fr
6、om the esophagus112Posterior mediastinal LNs separate from the esophagus and the esophageal hiatus5NO.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 origin of the celiac
7、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 bifurcation6胃癌淋巴结胃癌淋巴结CT上呈现上呈现v NO.1
8、7v NO.28v NO.3910v NO.411v NO.512v NO.613v NO.714v NO.815v NO.916v NO.1017v NO.1118v NO.1219v NO.1320v NO.1421v NO.1522v NO.1623淋巴结分期淋巴结分期24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：图注：RGEV:
9、 （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25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26淋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 intra
10、operative diagnoses of lymph node metastases remain unreliable, a D2 lymphadenectomy should be performed whenever nodal involvement is suspected.27淋巴结清扫范围淋巴结清扫范围v 全胃切除术全胃切除术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 t
11、he esophagus, D1+ includes:No. 110, D2 includes No. 19, 20, 110 and 111.28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+No. 8a, 9D2: D1+No. 8a, 9, 11p, 12a.29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
12、.D1+:D1+ No. 8a, 9, 11pFor tumors invading the esophagus, D1+includes No.110.30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31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： Locoregional nodes generally are suspicious for tumor involvement if round and/or 10 mm in short axis diameter. 32淋巴结清扫范围
13、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) of 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 distant metastases. v D0, D1,D2 same as JGCA
