• 1.四川大學(xué)華西醫(yī)院放射科（成都610041）;;
  • △進修生，原單位系四川省第四人民醫(yī)院CT室（成都610061）;;
  • 2.華中理工大學(xué)同濟醫(yī)院放射科（武漢430098）;;
  • 　3.成都鐵路中心醫(yī)院放射科（成都610078）;

目的探討膽囊癌腹部淋巴結(jié)轉(zhuǎn)移的分布特征及其相關(guān)CT、MR影像表現(xiàn)。方法以37例經(jīng)手術(shù)與病理檢查證實，并同時伴有中、上腹部區(qū)域內(nèi)淋巴結(jié)腫大（淋巴結(jié)短徑≥1.0 cm）的膽囊癌病例作為研究對象，其中31例行螺旋CT增強掃描，6例行MR掃描。由3位醫(yī)生集體閱片，著重觀察中、上腹部區(qū)域淋巴結(jié)的大小、位置及分布情況。結(jié)果該37例中，①門腔間隙胰頭后組腫大淋巴結(jié)出現(xiàn)率為89.1%（33/37），并主要分布于門腔間隙和胰頭后方； ②腹腔動脈干組腫大淋巴結(jié)出現(xiàn)率為78.3%（29/37），并主要分布在肝總動脈、腹腔動脈干周圍； ③腸系膜血管組腫大淋巴結(jié)出現(xiàn)率為29.8%（11/37），并分布于腸系膜上動脈胰后段周圍； ④腹主動脈組腫大淋巴結(jié)出現(xiàn)率為51.3%（19/37），并主要分布于左腎靜脈平面的腹主動脈左側(cè)和腹主動脈與下腔靜脈之間。結(jié)論 膽囊癌轉(zhuǎn)移所致的腫大淋巴結(jié)主要分布在門腔間隙胰頭后方、腹腔動脈干周圍、腸系膜上動脈周圍以及腹主動脈周圍。這種分布特點與膽囊胰后區(qū)、膽囊腹腔動脈干和膽囊腸系膜這3條膽囊淋巴引流途徑有關(guān)。CT和MR影像檢查可以準(zhǔn)確顯示膽囊癌淋巴結(jié)的轉(zhuǎn)移情況。

引用本文： 徐雋,宋彬,嚴志漢,劉再毅,陳衛(wèi)霞,陳憲,熊燕. 膽囊癌腹部轉(zhuǎn)移淋巴結(jié)分布特征的CT、MR表現(xiàn)探討. 中國普外基礎(chǔ)與臨床雜志, 2003, 10(1): 64-68. doi: 復(fù)制

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  2. 2. Chijiiwa K, Noshiro H, Nakano K, et al. Role of surgery for gallbladder carcinoma with special reference to lymph node metastasis and stage using western and Japanese classification systems [Ｊ]. World J Surg, 2000; 24(10)∶1271.
  3. 3. Ito M, Mishima Y, Sato T. An anatomical study of the lymphatic drainage of the gallbladder [Ｊ]. Surg Radiol Anat, 1991; 13(2)∶89.
  4. 4. Williams PL,Warwick R,Dyson M,eds.Gray’s Anatomy [M].37th ed.Edinburgh,Scotland: Churchill Livingstone, 1989∶818-820.
  5. 5. Tsukada K, Kurosaki I, Uchida K, et al. Lymph node spread from carcinoma of the gallbladder [Ｊ]. Cancer， 1997; 80(4)∶661.
  6. 6. 閔鵬秋，林珊，何之彥，等.門腔間隙病變CT、MRI特征探討 [Ｊ]. 中華放射學(xué)雜志， 1996; 30(1)∶6.
  7. 7. Dorfman RE, Alpern MB, Gross BH, et al. Upper abdominal lymph nodes: criteria for normal size determined with CT [Ｊ]. Radiology, 1991; 180(2)∶319.
  8. 8. Lerut T, Flamen P, Ectors N, et al. Histopathologic validation of lymph node staging with FDGPET scan in cancer of the esophagus and gastroesophageal junction: a prospective study based on primary surgery with extensive lymphadenectomy [Ｊ]. Ann Surg, 2000; 232(6)∶743.
  9. 9. Fujii H, Enomoto K, Ikeda T, et al. Lymph node metastasis from breast cancer diagnosed by F18 FDG wholebody PET (case report) [Ｊ]. Breast Cancer, 2000; 7(2)∶165.