直接淋巴管造影对胸导管出口梗阻的诊断价值  

The diagnostic value of direct lymphangiography for the thoracic duct outlet obstruction

作　　者：陈孝柏[1] 魏海亮[1] 张建梅[1] 沈文彬[2] 常鲲[2] 

机构地区：[1]首都医科大学附属北京世纪坛医院放射科,100038 [2]首都医科大学附属北京世纪坛医院淋巴外科,100038

出　　处：《中华放射学杂志》2013年第5期401-404,共4页Chinese Journal of Radiology

摘　　要：目的探讨直接淋巴管造影对胸导管出口梗阻的诊断价值。方法回顾性分析124例临床表现为淋巴水肿、乳糜胸、乳糜腹、乳糜尿和小肠淋巴管扩张症等患者的直接淋巴管造影资料，并与颈部胸导管手术探查结果进行对照分析。直接淋巴管造影对颈段胸导管的显示与胸导管手术探查情况进行对照，2名影像科医师在不知胸导管手术探查结果的情况下，阅读直接淋巴管造影后DSA造影结果，对手术侧颈干、锁骨下十、支气管纵隔干和胸导管末端人血梗阻的数值差异用Kappa值进行一致性分析。结果124例中，直接淋巴管造影显示淋巴反流：左颈干80例，左锁骨下干75例，左支气管纵隔干30例。胸导管出口入血障碍118例，与颈部胸导管手术探查结果对比分析，符合率分别为89．9％（80／89）、92．6％（75／81）、90．9％（30／33）和95．2％（118／124）。直接淋巴管造影对颈段胸导管的显示与探查情况进行对照，2名影像科医师阅读直接淋巴管造影后DSA造影结果具有高度一致性（K=0．82，P〈0．05）。另外，直接淋巴管造影显示腰干以下淋巴管不同程度迂曲、扩张和结构紊乱者114例（91．9％），无异常者仅10例（8．1％）；乳糜池以下不同程度反流者92例（74．2％）；肠干反流者16例（12．9％）；向肾区反流者11例（8．9％）；向心包反流者5例（4．0％）。伴有阴道淋巴漏7例（5．6％），腹膜后淋巴漏2例（1．6％），胸腔淋巴漏3例（2．4％），气管淋巴漏1例（0．8％）。结论直接淋巴管造影与颈部胸导管手术探查在显示胸导管出口梗阻的各种征象方面具有较高的一致性，直接淋巴管造影可作为胸导管末段手术探查的重要依据。Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction. Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema, Chylothorax, chylous ascites, chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration, 2 radiologists reviewed DLG DSA images in a double blind manner. The number of neck stem, subclavian stem, bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis. Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronehial-mediastinal lymphatic stem reflux, 118 patients showed the thoracic duct outlet barrier into the blood. The consistency rate of DLG were 89. 9% （ 80/89 ） ,92. 6% （ 75/81 ） ,90. 9% （ 30/33 ） and 95.2% （ 118/124 ） compared with the neck thoracic duct surgical exploration. Tow radiologists had a high degree of diagnostic consistency （ K = 0. 82,P 〈 0. 05 ）. In addition, 114 patients （91.9%） had tortuous, dilated waist lymphatic stem, only 10 patients （8. 1% ） were normal. The eisterna chyli reflux were found in 92 patients （74. 2% ）,intestinal stem reflux in 16 patients （12. 9% ）,reflux to the kidney area in 11 patients （8.9%）,to the pericardium reflux in 5 patients （4. 0% ）, vaginal lymphatic leakage in 7 patients （5.6%）, retroperitoneal lymph leakage in 2 patients （ 1.6% ） ,pleural lymphatic leakage in 3 patients （2. 4% ） ,tracheal lymph leakage in 1 patient （0. 8% ）. Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.

关 键 词：胸导管 淋巴管 淋巴造影术 

分 类 号：R5[医药卫生—内科学]