直接淋巴管造影后CT对生殖器淋巴水肿并乳糜瘘的诊断价值  

Evaluation of CT Scanning Performed after Direct Lymphangiography in Diagnosing Lymphedema Complicated by Lymphatic Leakage of Genital Organs

作　　者：宋建美[1] 陈孝柏[1] 沈文彬[1] 赵君[1] 王仁贵[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院放射中心,100038

出　　处：《临床放射学杂志》2014年第11期1691-1694,共4页Journal of Clinical Radiology

摘　　要：目的探讨直接淋巴管造影(DLG)后CT对生殖器淋巴水肿并乳糜瘘的诊断价值。方法回顾性分析32例生殖器淋巴水肿并乳糜瘘患者的影像学资料,所有患者均接受DLG、DLG后CT、核素淋巴显像检查。结果32例中,核素淋巴显像显示会阴部及男性阴茎、阴囊、女性外阴区显影增浓26例,23例胸导管扩张、出口受阻。DLG显示会阴部及男性阴茎、阴囊、女性外阴区反流22例,30例胸导管扩张、出口受阻。DLG后CT所见与其基本吻合,与DLG比较,DLG后CT发现了26例会阴部及男性阴茎、阴囊、女性外阴区的淋巴反流、8例肾区反流、3例肠干反流、6例胸腔反流。DLG后CT还发现了13例骨淋巴管瘤、4例腹盆腔淋巴管瘤、1例肾上腺腺瘤及盆腔畸胎瘤。结论 DLG后CT能够显示核素淋巴显像、DLG不易区分的复杂结构和微小病变,显示病变淋巴管周围的组织脏器情况,对于生殖器淋巴水肿并乳糜瘘患者术前明确病变的部位、范围及程度提供一定的帮助。Objective To assess the clinical value of CT scanning performed after direct lymphangiography in detecting lymphedema associated with lymphatic leakage of genital organs. Methods The imaging materials of 32 patients with lymphedema accompanied by lymphatic leakage of genital organs were retrospectively analyzed. Direct lymphangiography（ DLG） was carried out in all patients,which was followed by CT scanning and radionuclide lymphoscintigraphy. The results were analyzed. Results Of the 32 patients,radiotracer accumulation in male＇s perineal area,scrotum and female＇s vulva was seen on radionuclide lymphoscintigraphy in 26,and thoracic duct outlet obstruction was detected in 23. DLG showed that in 22 patients chylous reflux was demonstrated at male＇s perineal area,scrotum and at female＇s vulva,and in30 patients thoracic duct outlet obstruction was revealed. DLG findings were basically consistent with subsequent CT manifestations. Compare with DLG examination,subsequent CT scanning could detect more chylous reflux,including reflux to male＇s perineal area,scrotum and to female＇s vulva（ n = 26）,reflux to the kidney region（ n = 8）,intestinal stem reflux（ n = 3） and pleural lymphatic leakage（ n = 6）. In addition,CT examination after DLG could also detect Gorham-Stout syndrome in 13 patients,abdominal and pelvis angiolymphoma in 4 patients and adrenal adenoma together with pelvic dysembryoma in one patient. Conclusion CT scanning performed after direct lymphangiography can demonstrate complex structure as well as tiny lesions,which are difficult to be revealed on direct lymphangiography and radionuclide lymphoscintigraphy. On CT scan,the surrounding tissue can be clearly displayed,and the site and extent of lymphedema and lymphatic leakage of genital organs can be precisely located before surgery.

关 键 词：淋巴水肿 乳糜瘘 淋巴管造影 体层摄影 X线计算机 

分 类 号：R816.7[医药卫生—放射医学] R691[医药卫生—临床医学]