宫颈癌全段腹主动脉旁淋巴结转移的解剖分布和CTV边界

Anatomic distribution and clinical target volume margin of para‐aortic lymph node metastasis in cervical cancer

目的明确宫颈癌全段腹主动脉旁淋巴结转移的解剖学分布,探讨临床靶区(CTV)的勾画边界。方法回顾分析86例宫颈癌转移至腹主动脉旁淋巴结的患者。应用CT增强影像、淋巴结与周围结构的三维重建图像,明确腹主动脉旁转移淋巴结的解剖学边界。结果86例左肾静脉以下腹主动脉旁转移淋巴结,位于腹主动脉分叉处至左肾静脉上缘之间,沿腹主动脉和下腔静脉周围分布,在十二指肠出现后,下腔静脉右前方未发现肿大淋巴结。所有转移淋巴结均位于双侧卵巢血管和输尿管内侧,肠系膜下静脉紧邻其左前方;自上而下位于肾静脉、十二指肠、肠系膜血管后方;位于腰椎体和腰大肌前方。27例左肾静脉以上腹主动脉旁转移淋巴结,位于双侧膈脚后方,在腹主动脉后方沿奇静脉、半奇静脉上行,25/27例位于食管贲门交界水平(平第11胸椎)之下,5/27例伴有下腔静脉后内侧和右侧膈脚之间转移淋巴结,上界至腹腔干水平。结论推荐全段腹主动脉旁淋巴结CTV勾画边界:上界,平第11胸椎(食管贲门交界水平);左肾静脉以下侧界,肠系膜下静脉、卵巢血管和输尿管的内侧缘;左肾静脉以上侧界,双侧膈脚;前界,肾静脉以上腹主动脉的侧后壁、肾静脉、十二指肠、肠系膜血管的后缘;后界,腰椎体和腰大肌的前缘。

Objective To determine the regional boundary of para‐aortic lymph node(PAN)metastasis in cervical cancer,and to explore the clinical target volume(CTV)margin.Methods Eight‐six patients with cervical cancer metastasis to PAN below and above left renal vein(LRV)were retrospectively included in this study.The anatomical relationship of the metastatic PANs and surrounding structures were analyzed according tocontrast‐enhanced computed tomography(CT)and three dimensional reconstruction images.Results Eight‐six patients had metastatic PANs belowLRV:metastatic nodes were located onthe medial side of ovarian vessels and ureters,behind the renal veins,duodenum,mesenteric vessels,in front of the anterior border of lumbar vertebra and psoas.The inferior mesenteric vein was close to the left anterior side of PANs.Where the duodenum appeared,no node was presenton the anterolateral side of the inferior vena cava(IVC).Above the LRV,27 patients had retrocrural node involvement along the azygos and hemiazgos vein,and 25/27 cases were located below the junction level of cardia and oesophagus,and 5/27 patients had metastatic lymph nodes between IVC and the right crura of diaphragm,all below the level of coeliac trunk artery.Conclusions CTV margin delineation of PAN below and above LRV is recommended:superiorly,the junction level of cardia and oesophagus;laterally,crura and the medial side of ovarian vessels and ureters and inferior mesenteric vein;anteriorly,the posterior side of the coeliac trunk artery and renal veins and duodenum,mesenteric vessels;posteriorly,the anterior border of lumbar vertebra and psoas.