大网膜对胃癌扩散蔓延的影响及其受累的CT表现  

The influence of greater omentum on the spreading of gastric carcinoma： the CT features

作　　者：葛梅英[1] 尹化斌[1] 葛菁芳[1] 万凯明[1] 韩敏[1] 金航[2] 

机构地区：[1]复旦大学附属上海市第五人民医院放射科,上海200210 [2]复旦大学附属中山医院放射诊断科 复旦大学上海医学院影像学系 上海市影像医学研究所

出　　处：《实用放射学杂志》2012年第12期1902-1906,共5页Journal of Practical Radiology

基　　金：复旦大学附属上海市第五人民医院院级课题基金资助项目（2010YJ10）.

摘　　要：目的 探讨大网膜受胃癌侵犯的CT特征及其对胃癌病变向外扩散蔓延的影响。方法 回顾性分析27例胃部累及大网膜病例的CT增强扫描图像。包括胃癌病灶的形态、部位。胃癌累及大网膜的CT表现。大网膜在胃癌病变向外侵犯所起的引导怍用，伴随腹水的情况。结果 胃癌侵犯大网膜的CT表现包括：①直接浸润（11/27），包括胃结肠韧带脂肪密度增高、肿块形成，其中3例蔓延累及横结肠（3／27）；②种植转移（10／27），包括“污迹征”和网膜饼征，其中1例可处横结肠受累（1/27）；③淋巴结转移（12/27），包括淋巴结增大增多（10／27）和囊样灶（2／27）；④网膜血管曲张（1／27）。其中种植转移与伴随腹水情况的关系较为密切。结论 大网膜可被胃癌以多种方式侵犯，其CT增强扫描有多种表现，大网膜对胃癌病灶向邻近脏器如横结肠的侵犯，起着一定的引导作用。Objective To analyze the features of contrast enhanced CT of greater omentum（GO） involvement in gastric carcinoma（GC） and to ewduate the impact of GO on the spreading of GC. Methods CT findings in 27 GC patients with GO involved which confirmed by pathology were reviewed for primary tumor and the GO abnormalities as well as the role of GO in the spreading of GC.The relationship between the accompanied ascites and the different patterns of the omental involvement was also evalluated. Results CT features of the GO abnormalities caused by GC could be summarized as follows： ① direct invasion（11/27） , including spreadinginto the transverse colon via the gastrocolic ligament directly in 3 cases; ② omental seeding （ 10/27）, including ＂smudged＂ appear- ance and ＂omental caking＂, and the transverse colon was involved in one case; ③ lymph node metastasis （ 12/27）, including enlarge-ment and increase of lymph nodes （10/27） and cystic mass（2/27）; ④ varices of theomentum （1/27）. Ascites was seemed to he as sociated wilh the pattern of ornental seeding. Conclusion Greater omentum can be invaded by gastric carcinoma through several ways and contrast enhanced CT scan plays an important role in detecting CO involvement in C-C, which has a variety of CT manifesta tions. The GO can also be served as a potential pathway for the predictable spread of GC into the neighboring organs such as thetransverse colon.

关 键 词：胃癌 大网膜 腹膜下间隙 计算机体层成像 

分 类 号：R735.2[医药卫生—肿瘤] R814.42[医药卫生—临床医学]