小网膜受胃癌侵犯的CT表现及其对病变扩散蔓延的影响研究  

CT manifestation of lesser omentum invasion by gastric carcinaoma and the influence of lesser omentum on the gastric carcinoma spread

作　　者：葛梅英[1] 尹化斌[1] 葛菁芳[1] 万凯明[1] 俞忠辉[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200240 [2]复旦大学附属中山医院放射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》2014年第5期786-789,807,共5页Journal of Practical Radiology

基　　金：上海市闵行区自然科学研究课题基金资助项目（2013MHZ011）。

摘　　要：目的：分析小网膜受胃癌侵犯的 CT 表现及其对胃癌病变向外蔓延扩散的影响。方法回顾性探讨48例胃癌累及小网膜病例的 CT 图像,包括胃癌病灶的部位、形态,小网膜受累的 CT 征象,胃癌病变向外扩散蔓延的情况,分析伴随腹水的情况。结果胃癌累及小网膜的 CT 表现包括：①直接浸润（35.4%,17/48）,主要表现为小网膜脂肪密度增高、肿块形成,其中有2例蔓延累及肝脏（4.2%,2/48）；②种植转移（25.0%,12/48）,表现为污迹状（11例）和饼状改变（1例）；③淋巴结转移（64.6%,31/48）,包括淋巴结增大增多（27例）和囊样灶（4例）。腹腔积液11例,其中3例可见网膜囊积液,小网膜参与网膜囊构成,将网膜囊积液与大腹腔积液隔开,统计分析提示种植转移与伴随腹水的关系较为密切。结论胃癌可以多种方式侵犯小网膜,其 CT 扫描有多种表现。小网膜对胃癌病灶向外浸润扩散,起着一定的引导作用；对胃癌产生的腹水,起着一定的分隔作用。Objective To investigate the CT manifestations of gastric carcinoma invasion to lesser omentum and to assess the im-pact of lesser omentum on the spreading of gastric carcinoma.Methods We retrospectively reviewed CT findings in 48 patients with gastric carcinoma and lesser omentum involved for primary tumor and the lesser omentum abnormalities.The influence of lesser o-mentum on the extension of gastric carcinoma as well as the accompanied ascites were also analyzed.Results CT manifestations of lesser omentum involvement in gastric carcinoma included the following items：① direct infiltration （35.4%,1 7/48）,which was mainly shown as increased density of fatty tissue and the development of mass within the lesser omentum,including spreading into the liver through the lesser omentum directly in two cases;② omental seeding （25.0%,12/48）,including ＂smudged＂ appearance （1 1 cases）and ＂omental caking＂ （1 case）;③ metastasis of lymph nodes （64.6%,31/48）,including enlargement and increase of lymph nodes （27 cases）and cystic mass （4 cases）.Ascites was found in 1 1 patients and fluid collection in the lesser sac was shown in 3 of these 1 1 patients.The lesser omentum forms the anterior wall of the lesser sac and separates the fluid collection in the lesser sac from the ascites in the greater peritoneal cavity.Ascites was associated with the omental seeding statistically.Conclusion CT scan is helpful for detecting lesser omentum invasion by gastric carcinoma.The imaging features consist of mass sign,enlargement of lymph nodes,＂smudged＂ and＂caking＂appearance,and so on.Lesser omentum may also play a certain role in both the extension of gastric carcinoma and the compartmentalization of ascites due to gastric carcinoma.

关 键 词：胃癌 小网膜 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]