[基础医学]纵隔淋巴结分区解剖及影像学分区.ppt

纵隔淋巴结 纵隔淋巴结解剖 特点 ： 纵隔淋巴结平均数目为64个，大多数位于气管，　　　　　　 　支气管附近和大血管及食道周围． ⅠⅡⅣ 主要是位于气管旁的淋巴结 ⅢAⅤⅥ 主要是位于大血管旁的淋巴结 　ⅦⅩⅪ ⅩⅪ 主要是位于支气管旁的淋巴结 　 ⅢP Ⅷ 主要是位于食管周围淋巴结 　　 　　 Classification of Regional Lymph Nodes in Japan Classification of Regional Lymph Nodes in Japan Classification of Regional Lymph Nodes in Japan 　　　 　 Mountain and Dresler classification 　　system Mountain and Dresler classification system l区最高位纵隔气管前淋巴结  2区气管旁淋巴结 3区气管前、后或后纵隔（3P） 前纵隔（3a）淋巴结 4区气管与支气管交界处淋巴结  5区主动脉或Botallo淋巴结 6区主动脉（升主动脉）旁淋巴结 7区隆突下淋巴结  CT-based Definition of Thoracic Lymph Node Stations: an atlas from the university of Michigan ⅠⅡ （highest mediastinal and upper paratracheal nodes ） + Ⅲ区（prevascular nodes and retrotracheal nodes（图中未显示） Ⅳ区（ lower paratracheal nodes ） Ⅴ区 subaortic(aortic-pulmonary window) 主肺动脉窗 Ⅴ区与左喉返神经及膈神经的关系 左右喉返神经与纵隔淋巴结的关系 Ⅵ区（paraaortic nodes ） Ⅶ区(subcarinal nodes ) Ⅷ区 （paraeosphageal nodes ） Ⅸ区（Pulmonary ligament nodes） Ⅹ区（hilar nodes ） Ⅺ区（ interlobar nodes ） 各区肿大淋巴结 左上腔静脉 主动脉瘤 Prospective evaluation of computed tomography andmediastinoscopy in mediastinal lymph node staging Mediastinal Lymph Node Staging With FDG-PET Scan in Patients With Potentially Operable Non-smallCellLungCancer Meta-Analysis of Positron Emission Tomographic and Computed Tomographic Imaging in Detecting Mediastinal Lymph Node Metastases in Non-small Cell Lung Cancer Lymph Node Size and Metastatic Infiltration in Non-small Cell Lung Cancer  Real-time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes 头臂静脉弓水平 头臂静脉弓水平 主动脉弓水平 奇静脉弓水平 隆突水平 上叶支气管开口水平　 下叶支气管开口水平 　OR 隆突下３cm ⅠR ⅡR ⅣR Ⅴ Ⅶ Ⅷ ⅩⅪR ⅣL ⅡL ⅠL Ⅰ-Ⅱ　 左上叶支气管开口水平 Eur Respir J 1997; 10: 1547–1551 n=100 LNs larger than 1 cm were considered CT positive. N=50 LNs larger than 1.5 cm were considered CT positive Chest 1997;112;1480-1486 PET blinded to CT were significantly better (p=0.004): Ann Thorac