胃癌淋巴结转移CT阅片及相关知识点-陈开波淋巴淋巴结分分组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 part of AGED5 Suprapyloric LNs6 Infrapyloric LNs2NO.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 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 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 the3NO.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 LNs19 Infradiaphragmatic LNs predominantly along the subphrenicartery20 Paraesophageal LNs in the diaphragmatic esophageal hiatus110 Paraesophageal LNs in the lower thorax111 Supradiaphragmatic LNs separate from the esophagus112Posterior mediastinal LNs separate from the esophagus and the esophageal hiatus4NO.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 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 bifurcation5胃癌淋巴胃癌淋巴结CT上呈上呈现vNO.16vNO.27vNO.38大家学习辛苦了，还是要坚持继续保持安静继续保持安静9vNO.410vNO.511vNO.612vNO.713vNO.814vNO.915vNO.1016vNO.1117vNO.1218vNO.1319vNO.1420vNO.1521vNO.1622淋巴淋巴结分期分期23淋巴淋巴结分分组最新更新最新更新vJGCA第第5版胃癌治版胃癌治疗指南指南v幽幽门下区域淋巴下区域淋巴结亚分分类：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：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24淋巴淋巴结清清扫范范围v根据日本根据日本JGCA第四版胃癌治第四版胃癌治疗指南指南25淋巴淋巴结清清扫范范围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.26淋巴淋巴结清清扫范范围v全胃切除全胃切除术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 111.27淋巴淋巴结清清扫范范围v远端胃切除端胃切除术D0: Lymphadenectomy less than D1.D1: No. 1, 3, 4sb, 4d, 5, 6, 7D1+:D1+No. 8a, 9D2: D1+No. 8a, 9, 11p, 12a.28淋巴淋巴结清清扫范范围v近端胃切除近端胃切除术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.110.29淋巴淋巴结清清扫范范围v胃食管交界癌胃食管交界癌30淋巴淋巴结清清扫范范围v美国美国AJCC第第8版胃癌指南版胃癌指南区域淋巴区域淋巴结概念：概念： 远处淋巴淋巴结概念：概念： Locoregional nodes generally are suspicious for tumor involvement if round and/or 10 mm in short axis diameter. 31淋巴淋巴结清清扫范范围vNCCN 2017. v3 胃癌治胃癌治疗指南指南v清清扫15个个vThe 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. vThe 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. vMore distant nodes, including para aortic (N3 and N4), are regarded as distant metastases. vD0, D1,D2 same as JGCA32