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EndoTODAY ³»½Ã°æ ±³½Ç


[Abdominal lymph node stations in CT] - ðû

CT¿¡¼­ ¸²ÇÁÀý ÀüÀÌ°¡ ÀÖÀ¸¸é C77.2 ÄÚµå ÀÔ·Â!


1. ¸²ÇÁÀý ¸í¸í¹ý

ÀϺ» À§¾Ï °¡À̵å¶óÀÎ 3ÆDZîÁö´Â À§¾Ï º´¼ÒÀÇ À§Ä¡¿¡ µû¶ó ¸²ÇÁÀýÀ» N1 node, N2 node, N3 node·Î ³ª´©¾î ºÒ·¶½À´Ï´Ù.

ÀϺ» À§¾Ï °¡À̵å¶óÀÎ 4ÆÇ(2014)ºÎÅÍ´Â ¼ö¼ú Á¾·ù¿¡ µû¶ó node°¡ °áÁ¤µË´Ï´Ù. Subtotal gastrectomyÀÇ °æ¿ì ¹«½¼ ¹«½¼ node±îÁö ¼ö¼úÇϸé D1 dissection, ¹«½¼ ¹«½¼ node±îÁö ¼ö¼úÇϸé D2 dissectionÀ¸·Î ºÎ¸£´Â ½ÄÀÔ´Ï´Ù. ¾ÆÁ÷ ¸¹Àº º´¿ø¿¡¼­ ½À°üÀûÀ¸·Î ¸»ÇÏ°í ÀÖ´Â D1+alpha, D1+beta µîµµ »ç½Ç ±¸¹öÀüÀÔ´Ï´Ù. ÃÖ±Ù¿¡´Â D1+ ¿¡ Ãß°¡·Î ÀýÁ¦ÇÑ ¸²ÇÁÀý ¹øÈ£¸¦ Àû´Â °ÍÀÌ ±ÇÀåµÇ°í ÀÖ½À´Ï´Ù. ¿¹¸¦ µé¸é D1 (+ No. 8a), D2 (-No. 10)°°Àº ¹æ½ÄÀÌÁö¿ä.

¸ðµÎ ´Ù ¿Ü¿ï ¼ö ¾øÁö¸¸, 1ºÎÅÍ 7¹ø±îÁöÀÇ ¸²ÇÁÀý À§Ä¡¿Í À̸§À» ¾Ë°í ÀÖÀ¸¸é ¿©·¯¸ð·Î µµ¿òÀÌ µË´Ï´Ù. ¾Æ·¡ ±×¸²À» º¸½Ê½Ã¿ä. »ý°¢º¸´Ù ¾î·ÆÁö ¾Ê½À´Ï´Ù. Á¿ì ¦(pair)À¸·Î µÇ¾î ÀÖÀ¸´Ï±î.


2. ¸²ÇÁÀý¿¡ µû¸¥ À§¾Ï staging

À§¾Ï º´±â ¼³Á¤¿¡¼­ AJCC 7th (2009)¿¡¼­´Â N3a¿Í N3b¸¦ ³ª´©Áö ¾Ê¾Ò´Âµ¥ AJCC 8th (2017)ºÎÅÍ´Â N3a¿Í N3b¸¦ ³ª´©°í ÀÖ½À´Ï´Ù (Transl Gastroenterol Hepatol 2019).

Surgical Oncology 2018;27:146

AJCC 8th (2017)¿¡¼­ À§ ÁÖÀ§ ¸²ÇÁÀýÀÌ ¾Æ´Ñ ´Ù¸¥ ¸²ÇÁÀý ħ¹üÀÌ ÀÖÀ¸¸é ÀüÀÌ(M1)À¸·Î °£ÁÖÇÕ´Ï´Ù. ÀÌ¿¡ ÇØ´çÇÏ´Â ¸²ÇÁÀý¿¡´Â retropancreatic, pancreaticoduodenal, peripancreatic, superior mesenteric, middle colic, para-aortic, retroperitoneal node µîÀÔ´Ï´Ù.


3. CT¿¡¼­ º¹ºÎ ¸²ÇÁÀýÀ» ã°í À̸§ºÙÀÌ´Â ¹æ¹ýÀ» ¼Ò°³ (BJR 2007)

gastro-oesophageal (black); hepatic artery (aqua); splenic (pink); gastro-omental (light purple); left gastric (blue); hepatoduodenal ligament (orange)

left gastric (pink); greater curvature (blue); left inferior phrenic (green)

lesser curvature (light blue); hepatic artery (blue); greater curvature (green); pericolic (pink); middle colic (red)

greater curvature (blue); right gastric (red); right colic (yellow)

gastroduodenal (green); pericolic (pink); superior mesenteric (light blue); interaortocaval (yellow); right gastroepiploic (red)

right gastroepiploic (light blue); periportal (green); superior mesenteric (yellow); inferior pancreatic (red)

splenic (yellow); periportal (green); anterior pancreatic (red); hepatic (orange)

coeliac axis (green); hepatoduodenal (blue); common hepatic (red)

coeliac axis (yellow); splenic (green); greater omental (light blue); anterior pancreaticoduodenal (pink); posterior pancreaticoduodenal (blue); pancreatic inferior (red)

juxtaintestinal (green); renal hilar (light blue); superior mesenteric (yellow)

lateral aortic (light blue); right gastroepiploic (yellow); interaortocaval (blue); pyloric (green); superior mesenteric (pink)

renal hilar (green); retro-aortic (light blue); superior mesenteric (pink)

lateral aortic (yellow); retrocaval (green); interaortocaval (light blue); juxtaintestinal (red); pericolic (pink); left colic (dark blue)

lateral aortic (yellow); retrocrural (red), inferior diaphragmatic (blue), middle colic (green)

anterior diaphragmatic (green), gastro-oesophageal (blue); middle diaphragmatic (red)


[Cases]

Retroperitoneal node Áß aortic node´Â aortic hiatus, para-aortic middle, para-aortic caudal·Î ³ª´©¾îÁý´Ï´Ù. "Multiple lymph node metastases along left gastric artery, common hepatic artery, perigastric area, portocaval space, retroperitoneal space below the renal vein level (16B)"·Î Æǵ¶µÇ¾ú´ø ȯÀÚÀÇ 16B nodeÀÔ´Ï´Ù. (52¼¼ ³²¼º, 2018)


[FAQs]

[2021-8-30. ÀÌÁØÇà Áú¹®]

¾È³çÇϽʴϱî? ¹®µæ Áú¹® Çϳª µå¸³´Ï´Ù. CT¿¡¼­ portocaval space ¿¡¼­ ¸²ÇÁÀýÀÌ º¸Àδٰí ÇÏ¸é ¸î ¹ø node¸¦ ¸»ÇÏ´Â °ÍÀϱî¿ä? 12¹øÀϱî¿ä, 8aÀϱî¿ä? ³»°ú ÀÇ»çÀÇ ¹«½ÄÇÑ Áú¹® ¾çÇعٶø´Ï´Ù.

[2021-8-30. ¿Ü°ú ¾ÈÁö¿µ ±³¼ö´Ô ´äº¯]

12p ·Î º¸¸é µÉ °Í °°°í º¸Åë ¼ö¼ú·Î ÀýÁ¦ÇÏÁö´Â ¾Ê´Â ºÎºÐÀÔ´Ï´Ù


[References]

1) Moroi. BJR 2007

2) À§¾Ïº´¸® °¡À̵å¶óÀÎ (2023) - ¿ì¸®¸» version

3) AJCC 8th Çؼ³ (±è¼ºÀº)

4) AJCC 8th PPT ÀÎÅÍ³Ý ÀÚ·á

5) NCCN (2022)

6) EndoTODAY À§¾Ï 504 - 4¹ø node ÀüÀÌ Áõ·Ê

© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.