直接淋巴管造影术在原发性乳糜尿诊断中的应用  

Application of direct lymphangiography in the diagnosis of primary chyluria

作　　者：信建峰[1] 孙宇光[1] 夏松[1] 常鲲[1] 朱研[1] 刘昕[1] 安然[1] 沈文彬[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院淋巴外科,100038

出　　处：《中华医学杂志》2013年第28期2212-2214,共3页National Medical Journal of China

摘　　要：目的探讨直接淋巴管造影术对原发性乳糜尿的诊断作用。方法经单侧足背淋巴管注入碘化油，使用Innova2100．IQ数字平板血管造影系统，分时段动态连续采集图像观察淋巴系统显影情况。结果25例患者行直接淋巴管造影术均显示一侧（18例）或双侧（7例）肾脏造影剂反流；21例伴随腹膜后淋巴管扩张、迂曲，13例造影剂向盆腔及（或）对侧骶髂部反流；22例胸导管颈段末段（18例）或颈段全程（4例）狭窄，胸段、腹段增粗扩张，5例胸导管末端未见造影剂入血，17例可见少量造影剂入血；1例胸导管颈段、胸段未见显影，2例胸导管颈段及部分胸段纤细。结论直接淋巴管造影术可动态观察乳糜（淋巴液）的回流改变，能够清晰显示原发性乳糜尿肾区乳糜反流的位置、病变范围、程度。在原发性乳糜尿的成因中胸导管颈段梗阻起重要作用。Objective To discuss the role of direct lymphangiography in the diagnosis of primary chyluria. Methods Iodized oil was infused into lymphatic vessel of unilateral foot in 25 cases. The condition of lymphatic system imaging was dynamically observed via Innova 2100-tQ digital flat-panel angiography system. Results All of them underwent direct lymphangiography. The results revealed unilateral（ n = 18） or bilateral （ n = 7） renal reflux of contrast media. Among 22 stenotic cases, there were partial（ n = 18 ） or whole （ n = 4） cervical section of thoracic duct, no imaging in cervicothoracic section of thoracic duct （ n = 1 ） ; thin imaging in cervical section and partial thoracic section （ n -- 2） ; retroperitoneal lymphangictasia ＆ tortuous lymphatic vessels （ n = 21 ） ; reflux of contrast medium to pelvic and/or contralateral sacroiliac part （ n = 13）. Conclusion Capable of acquiring dynamic images of chyle （lymph） circulation, direct lymphangiography provides accurate estimation for the location, scope, extent of lesions of renal chylous reflux in primary chyluria so as to guide surgery. Stenotic cervical section of thoracic duct plays an important etiologic role in primary chyluria.

关 键 词：淋巴管造影术 乳糜尿 胸导管 

分 类 号：R696.8[医药卫生—泌尿科学]