胃癌根治术后胃左动脉旁淋巴结在螺旋CT中的定位
|
摘要
目的：测量并确定胃左动脉旁淋巴结在螺旋CT中的区域范围,指导胃癌根治术后放疗靶区的勾画。
方法：对36例胃癌患者手术时在胃左动脉根部放置钛夹。螺旋CT下采取放疗体位行三期增强扫描、冠状位及矢状位重建,以T12椎体为参考点,测量胃左动脉旁淋巴结的三维方向,应用SPSS 17.0统计学软件计算分析其分布,测算胃左动脉旁淋巴结根部所在位置的变异范围。
结果：通过Ko lmogorov-Smirnov检验,全组在各边界近似服从正态分布,男、女在胃左动脉旁淋巴结的分布趋势上是一致的。Pearson分析显示胃左动脉旁淋巴结的边界与年龄、身高、体重、椎体高、椎体宽无相关性。男、女胃左动脉旁淋巴结的前界分别为垂直于T12椎体最前缘切线46.56±1.95mm、37.56±-2.35mm；后界分别为17.50±2.02mm、16.44±2.34mm；左界分别为距T12椎体左缘右22.48±2.04mm、16.03±2.25mm；右界分别为距T12椎体左缘左14.33±2.12mm、5.53±2.35mm：上界分别为距T12椎体上缘上26.89±2.12mm、16.09±2.30mm；下界分别为距T12椎体下缘下9.58±2.13mm、8.58±2.36mm。
结论：男、女胃左动脉旁淋巴结在螺旋CT中的范围分别约为：前界垂直于T12椎体最前缘切线48.51mm、39.91ram；后界垂直于T12椎体最前缘切线15.48mm、14.10mm；左界距T12椎体左缘右24.52mm、18.28mm；右界距T12椎体左缘左16.45mm、7.88mm；上界距T12椎体上缘上29.01mm、18.39mm；下界距T12椎体下缘下11.71mm、10.94mm。
Objective:To measure and define the region-wide of left gastric artery lymph nodes, to guide radiotherapy target volume delineation after radical operation of gastric cancer.
Methods:Titanium clips were set around the root left gastric artery in 36 patients with gastric carcinoma at the time of surgery. Under the spiral Computer Tomography(CT), enhancement scanning were taken in the radio-therapeutic position, the coronal view and sagittal view were reconstituted. Then, T12 vertebral body as reference point, measurement of left gastric artery lymph nodes in the three-dimensional direction. With SPSS 17.0 software, range of variation of localization of the root of left gastric artery lymph nodes were obtained.
Results:According to the analysis of Kolmogorov-Smirnov test, each border was of approximate normal distribution, Male and female groups in the left gastric artery lymph nodes on the distribution of the trend is consistent. Pearson Correlation Coefficients analysis did not suggest a significant relationship between the border and age, height, weight and size of vertebral body. The anterior boundary's most leading edge perpendicular to the T12 vertebral body tangent of male and female left gastric artery lymph nodes were 46.56±1.95mm,37.56±2.35mm; the posterior boundary is respectively 17.50±2.02mm,16.44±2.34mm; the left boundary is respectively from the T12 vertebra left margin, right 22.48±2.04mm,16.03±2.25mm; the right boundary is respectively from the T12 left margin, left 14.33±2.12mm,5.53±2.35mm; the upper bound respectively from the T12 vertebral body on the edge of 26.89±2.12mm, 16.09±2.30mm; the lower bound respectively from the T12 vertebra body lower edge,9.58±2.13mm,8.58±2.36mm.
Conclusion:Male and female left gastric artery lymph node in spiral CT in the range are approximately perpendicular to the T12 vertebral body: former world foremost edge tangent 48.51mm,39.91mm; T12 vertebral body after circles perpendicular to the front line 15.48mm,14.10mm; left the sector from the T12 vertebra left margin of the right 24.52mm,18.28mm; T12 vertebral body right sector from the left margin left 16.45mm,7.88mm; Upper bound of T12 from the vertebral body on the edge of 29.01mm, 18.39mm; lower bound from the T12 vertebral body lower edge,11.71mm, 10.94mm.
方法：对36例胃癌患者手术时在胃左动脉根部放置钛夹。螺旋CT下采取放疗体位行三期增强扫描、冠状位及矢状位重建,以T12椎体为参考点,测量胃左动脉旁淋巴结的三维方向,应用SPSS 17.0统计学软件计算分析其分布,测算胃左动脉旁淋巴结根部所在位置的变异范围。
结果：通过Ko lmogorov-Smirnov检验,全组在各边界近似服从正态分布,男、女在胃左动脉旁淋巴结的分布趋势上是一致的。Pearson分析显示胃左动脉旁淋巴结的边界与年龄、身高、体重、椎体高、椎体宽无相关性。男、女胃左动脉旁淋巴结的前界分别为垂直于T12椎体最前缘切线46.56±1.95mm、37.56±-2.35mm；后界分别为17.50±2.02mm、16.44±2.34mm；左界分别为距T12椎体左缘右22.48±2.04mm、16.03±2.25mm；右界分别为距T12椎体左缘左14.33±2.12mm、5.53±2.35mm：上界分别为距T12椎体上缘上26.89±2.12mm、16.09±2.30mm；下界分别为距T12椎体下缘下9.58±2.13mm、8.58±2.36mm。
结论：男、女胃左动脉旁淋巴结在螺旋CT中的范围分别约为：前界垂直于T12椎体最前缘切线48.51mm、39.91ram；后界垂直于T12椎体最前缘切线15.48mm、14.10mm；左界距T12椎体左缘右24.52mm、18.28mm；右界距T12椎体左缘左16.45mm、7.88mm；上界距T12椎体上缘上29.01mm、18.39mm；下界距T12椎体下缘下11.71mm、10.94mm。
Objective:To measure and define the region-wide of left gastric artery lymph nodes, to guide radiotherapy target volume delineation after radical operation of gastric cancer.
Methods:Titanium clips were set around the root left gastric artery in 36 patients with gastric carcinoma at the time of surgery. Under the spiral Computer Tomography(CT), enhancement scanning were taken in the radio-therapeutic position, the coronal view and sagittal view were reconstituted. Then, T12 vertebral body as reference point, measurement of left gastric artery lymph nodes in the three-dimensional direction. With SPSS 17.0 software, range of variation of localization of the root of left gastric artery lymph nodes were obtained.
Results:According to the analysis of Kolmogorov-Smirnov test, each border was of approximate normal distribution, Male and female groups in the left gastric artery lymph nodes on the distribution of the trend is consistent. Pearson Correlation Coefficients analysis did not suggest a significant relationship between the border and age, height, weight and size of vertebral body. The anterior boundary's most leading edge perpendicular to the T12 vertebral body tangent of male and female left gastric artery lymph nodes were 46.56±1.95mm,37.56±2.35mm; the posterior boundary is respectively 17.50±2.02mm,16.44±2.34mm; the left boundary is respectively from the T12 vertebra left margin, right 22.48±2.04mm,16.03±2.25mm; the right boundary is respectively from the T12 left margin, left 14.33±2.12mm,5.53±2.35mm; the upper bound respectively from the T12 vertebral body on the edge of 26.89±2.12mm, 16.09±2.30mm; the lower bound respectively from the T12 vertebra body lower edge,9.58±2.13mm,8.58±2.36mm.
Conclusion:Male and female left gastric artery lymph node in spiral CT in the range are approximately perpendicular to the T12 vertebral body: former world foremost edge tangent 48.51mm,39.91mm; T12 vertebral body after circles perpendicular to the front line 15.48mm,14.10mm; left the sector from the T12 vertebra left margin of the right 24.52mm,18.28mm; T12 vertebral body right sector from the left margin left 16.45mm,7.88mm; Upper bound of T12 from the vertebral body on the edge of 29.01mm, 18.39mm; lower bound from the T12 vertebral body lower edge,11.71mm, 10.94mm.
引文
[1]胃癌研究会编.胃癌取极ぃ規約(改定第12版).东京：金原出版株式会社,1993；1257
[2]李彦磊,赵园园,何信佳,于丽,张碧媛,尚庆军,安永恒.胃癌根治术后复发区域的研究.齐鲁医学杂志,2011,26(5)
[3]何裕隆,张常华,詹文华,汪建平,蔡世荣,黄美近,陈创奇.胃癌孤立性淋巴结转移的分析.中华普通外科杂志,2005年5月第20卷第5期
[4]恩藏戈·杰西,詹文华,汪建平,董文广,兰平,何裕隆,陈正煊,蔡世荣.进展期胃癌的淋巴结转移特点及其临床意义.中华胃肠外科杂志,2006年06期
[5]金晶.胃癌.见：殷蔚伯,谷铣之,主编.肿瘤放射治疗学(第四版).北京：中国协和医科大学出版社,2002.819.
[6]郑安平,冯连杰,张卫民,等.988例食管癌放射野外淋巴结转移的研究.中华放射肿瘤学杂志,1999,8：133.135.
[7]杨宗贻,苗延浚,张志贤,等.食管癌放疗中胃左血管区淋巴结位置的定位标志.中国放射肿瘤学,1991,5：66-67.
[8]钱普东,冯纯伟,郭业松,等.124例癌症患者胃左淋巴结标记分析.中华放射肿瘤学杂志,1999,9：401-4.5.
[1]NCCN胃癌临床实践指南(中国版)2011年(第一版)
[2]朱正纲.胃癌术后复发的有关问题及综合治疗.中国实用外科杂,2005,25：181.
[3]詹友庆,李威,孙晓卫,等.胃癌外科治疗的远期疗效研究.中华外科杂志,2005,43：1109.
[4]王敏桦,孙菁,曾昭冲,杜世锁,曾蒙苏,孙益红.胃癌术后复发转移类型及其对放疗靶区设计的临床意义.实用肿瘤杂志；2007年03期
[5]李彦磊,赵园园,何信佳,于丽,张碧媛,尚庆军,安永恒.胃癌根治术后复发区域的研究.齐鲁医学杂志,2011,26(5).
[6]Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J]. N Engl J Med,2001,345(10):725.
[7]Macdonal JS, Smally S, Benedetti J, et al. Postoperative combined radiation and chemotherapy improves disease～free survival (DFS) and overall survival (OS) in resected adenocarcinoma of the stomach and gastroesophageal junction:Update of the results of Intergroup Study INT-0116 (SWOG9008)[C]. ASCO GI Symposium,2004.
[8]Macdonald JS, Benedetti J, Smalley S, et al. Chemoradiation of resected gastric cancer:A 10～year follow～up of the phase Ⅲ trial INT-0116 (SWOG 9008). J Clin Oncol (Meeting Abstracts) 2009; 27:4515-
[9]Kim S, Lim DH, Lee J, et al. An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinolna of the stomach. Int J Radiat Oncol Biol Phys,2005,63(5):1279.
[10]David D, Smith, Rebecca Ket al. Impact of Total Lymph Node Count on Staging and Survival After Gastrectomy for Gastric Cancer:Data From a Large US-Population Database. J Clin Oncol,2005,23(28):7114-7124.
[11]Buskem C J, Ten Kate FJW, Obertop H, et al. Analysis of micrometastatic disease in histologically negative lymph nodes of patients with adenocarcinoma of the distal esophagus or gastric cardia. Diseases of the Esophagus,2007,21:488-495.
[12]Michael D'Angelica, Mithat Gonen, Murray F. Brennan, et al. Patterns of Initial Recurrence in Completely Resected Gastric Adenocareinoma, Ann Surg,2004,240: 816.
[13]Wieland C, Hymmen U. Mega～volt therapy of malignant stomach neoplasms[J]. Strahlentherapie,1970,140(1):20.
[14]Klaassen DJ, Maclntyre JM, Catton GE, et al. Treatment of locally unrespectable cancer of the stomach and pancreas:a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil-an eastern cooperative oncology group study [J]. J Clin Oncol.1985,3(3):373
[15]Hartgrink HH, van de Velde CJ. Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer[J].J Surg Oncol,2005,90 (3):153-165
[16]Ringash J, Khaksary SJ, Oza A, et al. Post-operative Radiochemotherapy for Gastric Cancer:Adoption and Adaptation. Clinical Oncology.2005,17:91-95.
[17]Zahra Kassam, Gina Lockwood, Catherine 0'Brien, et al. Conformal radiotherapy in the adjuvant therapy of gastric cancer:review of 82 cases, hat. J. Radiation Oncology Biol. Phys,2006,65:710-719.
[18]Lohr F, Dobler B, Mai S, et al. Optimization of dose distributions for adjuvant locoregional radiotherapy of gastric cancer by IMRT. Strahlenther Onkol,2003,179(8): 557.
[19]Ringash J, Perkins G Brierley J, et al. IMRT for adjuvant radiation in gastric cancer:a preferred plan. Int J Radiat Oncol Biol Phys.2005,63(3):732.
[20]胃癌研究会编.胃癌取极ぃ規約(改定第12版).东京：金原出版株式会社,1993；1257
[21]Gaudry M, Ratoanina JL, Escarmant P, et al. Target volume in radiotherapy of gastric adenocarcinoma. Cancer Radiother.2001.523-33.
[22]Smalley SR, Gunderson L, Tepper J, et al. Gastric surgical adjuvant radio therapy consensus report:rationale and treatment implementation. Int J Radiat Oncol Biol Plays, 2002,52(2):283-293.
[23]Lee J, Kang W, Lim D, et al. Phase Ⅲtrial of adjuvant capecitabine/cisplatin (XP) versus capecitabine/cisplatin/RT (XPRT) in resected gastric cancer with D2 nodal dissection (ARTIST trial):Safety analysis. J Clin Oncol (Meeting Abstracts) 2009; 27:4537:
[2]李彦磊,赵园园,何信佳,于丽,张碧媛,尚庆军,安永恒.胃癌根治术后复发区域的研究.齐鲁医学杂志,2011,26(5)
[3]何裕隆,张常华,詹文华,汪建平,蔡世荣,黄美近,陈创奇.胃癌孤立性淋巴结转移的分析.中华普通外科杂志,2005年5月第20卷第5期
[4]恩藏戈·杰西,詹文华,汪建平,董文广,兰平,何裕隆,陈正煊,蔡世荣.进展期胃癌的淋巴结转移特点及其临床意义.中华胃肠外科杂志,2006年06期
[5]金晶.胃癌.见：殷蔚伯,谷铣之,主编.肿瘤放射治疗学(第四版).北京：中国协和医科大学出版社,2002.819.
[6]郑安平,冯连杰,张卫民,等.988例食管癌放射野外淋巴结转移的研究.中华放射肿瘤学杂志,1999,8：133.135.
[7]杨宗贻,苗延浚,张志贤,等.食管癌放疗中胃左血管区淋巴结位置的定位标志.中国放射肿瘤学,1991,5：66-67.
[8]钱普东,冯纯伟,郭业松,等.124例癌症患者胃左淋巴结标记分析.中华放射肿瘤学杂志,1999,9：401-4.5.
[1]NCCN胃癌临床实践指南(中国版)2011年(第一版)
[2]朱正纲.胃癌术后复发的有关问题及综合治疗.中国实用外科杂,2005,25：181.
[3]詹友庆,李威,孙晓卫,等.胃癌外科治疗的远期疗效研究.中华外科杂志,2005,43：1109.
[4]王敏桦,孙菁,曾昭冲,杜世锁,曾蒙苏,孙益红.胃癌术后复发转移类型及其对放疗靶区设计的临床意义.实用肿瘤杂志；2007年03期
[5]李彦磊,赵园园,何信佳,于丽,张碧媛,尚庆军,安永恒.胃癌根治术后复发区域的研究.齐鲁医学杂志,2011,26(5).
[6]Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction[J]. N Engl J Med,2001,345(10):725.
[7]Macdonal JS, Smally S, Benedetti J, et al. Postoperative combined radiation and chemotherapy improves disease～free survival (DFS) and overall survival (OS) in resected adenocarcinoma of the stomach and gastroesophageal junction:Update of the results of Intergroup Study INT-0116 (SWOG9008)[C]. ASCO GI Symposium,2004.
[8]Macdonald JS, Benedetti J, Smalley S, et al. Chemoradiation of resected gastric cancer:A 10～year follow～up of the phase Ⅲ trial INT-0116 (SWOG 9008). J Clin Oncol (Meeting Abstracts) 2009; 27:4515-
[9]Kim S, Lim DH, Lee J, et al. An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinolna of the stomach. Int J Radiat Oncol Biol Phys,2005,63(5):1279.
[10]David D, Smith, Rebecca Ket al. Impact of Total Lymph Node Count on Staging and Survival After Gastrectomy for Gastric Cancer:Data From a Large US-Population Database. J Clin Oncol,2005,23(28):7114-7124.
[11]Buskem C J, Ten Kate FJW, Obertop H, et al. Analysis of micrometastatic disease in histologically negative lymph nodes of patients with adenocarcinoma of the distal esophagus or gastric cardia. Diseases of the Esophagus,2007,21:488-495.
[12]Michael D'Angelica, Mithat Gonen, Murray F. Brennan, et al. Patterns of Initial Recurrence in Completely Resected Gastric Adenocareinoma, Ann Surg,2004,240: 816.
[13]Wieland C, Hymmen U. Mega～volt therapy of malignant stomach neoplasms[J]. Strahlentherapie,1970,140(1):20.
[14]Klaassen DJ, Maclntyre JM, Catton GE, et al. Treatment of locally unrespectable cancer of the stomach and pancreas:a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil-an eastern cooperative oncology group study [J]. J Clin Oncol.1985,3(3):373
[15]Hartgrink HH, van de Velde CJ. Status of extended lymph node dissection: locoregional control is the only way to survive gastric cancer[J].J Surg Oncol,2005,90 (3):153-165
[16]Ringash J, Khaksary SJ, Oza A, et al. Post-operative Radiochemotherapy for Gastric Cancer:Adoption and Adaptation. Clinical Oncology.2005,17:91-95.
[17]Zahra Kassam, Gina Lockwood, Catherine 0'Brien, et al. Conformal radiotherapy in the adjuvant therapy of gastric cancer:review of 82 cases, hat. J. Radiation Oncology Biol. Phys,2006,65:710-719.
[18]Lohr F, Dobler B, Mai S, et al. Optimization of dose distributions for adjuvant locoregional radiotherapy of gastric cancer by IMRT. Strahlenther Onkol,2003,179(8): 557.
[19]Ringash J, Perkins G Brierley J, et al. IMRT for adjuvant radiation in gastric cancer:a preferred plan. Int J Radiat Oncol Biol Phys.2005,63(3):732.
[20]胃癌研究会编.胃癌取极ぃ規約(改定第12版).东京：金原出版株式会社,1993；1257
[21]Gaudry M, Ratoanina JL, Escarmant P, et al. Target volume in radiotherapy of gastric adenocarcinoma. Cancer Radiother.2001.523-33.
[22]Smalley SR, Gunderson L, Tepper J, et al. Gastric surgical adjuvant radio therapy consensus report:rationale and treatment implementation. Int J Radiat Oncol Biol Plays, 2002,52(2):283-293.
[23]Lee J, Kang W, Lim D, et al. Phase Ⅲtrial of adjuvant capecitabine/cisplatin (XP) versus capecitabine/cisplatin/RT (XPRT) in resected gastric cancer with D2 nodal dissection (ARTIST trial):Safety analysis. J Clin Oncol (Meeting Abstracts) 2009; 27:4537: