联合应用CT淋巴管成像与直接淋巴管造影诊断原发性小肠淋巴管扩张症的价值  

Value of CT lymphangiography combined with direct lymphangiography in diagnosing primary intestinal lymphangiectasia

作　　者：董健[1] 沈文彬[2] 信建峰[2] 霍萌[1] 刘鹏飞[3] 温廷国[1] 王仁贵[1] 陈孝柏[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 [2]首都医科大学附属北京世纪坛医院淋巴外科,100038 [3]首都医科大学附属北京世纪坛医院麻醉科,100038

出　　处：《中华放射学杂志》2017年第5期362-365,共4页Chinese Journal of Radiology

摘　　要：目的 探讨联合应用CT淋巴管成像（CTL）和直接淋巴管造影（DLG）诊断小肠淋巴管扩张症（PIL）的价值.方法 回顾性分析经内镜活检和（或）手术病理证实为PIL,且在剖腹探查前1周内行DLG和CTL检查的16例患者.评价DLG、CTL联合DLG诊断PIL的小肠局部及小肠外表现,并观察手术及病理表现.结果 DLG表现包括胸、腹、盆腔淋巴回流缓慢16例,淋巴管扩张9例,盆腔淋巴反流9例,淋巴腹腔瘘1例,胸导管出口功能障碍14例.CTL联合DLG检查的小肠局部表现：小肠肠管扩张16例,肠壁环状增厚14例.CTL联合DLG检查的小肠外表现包括水肿样表现（肠系膜肿胀12例、腹腔积液7例、胸腔积液合并腹腔积液2例、腹腔胸腔合并心包积液3例）,腹腔内淋巴结增大（6例）,淋巴管扩张及分布异常（14例）,瘘（淋巴-小肠腔内瘘4例、淋巴-腹腔瘘3例）,淋巴管瘤样病变（3例）,胸导管末段出口功能障碍及反流（14例）.小肠内镜诊断小肠淋巴管扩张、肠腔内淋巴渗出和肠腔内淋巴漏出的分别为16、10、6例,DLG联合CTL诊断的分别11、0、4例.结论 CTL与DLG联合应用诊断PIL具有较大价值.Objective To investigate the clinical value of CT lymphangiography （CTL） combined with direct lymphangiography （DLG） in primary intestinal lymphangiectasia （PIL）. Methods Sixteen patients diagnosed as PIL with intestinal enteroscopy were recruited in this retrospective study. All the patients were performed DLG and CTL one week before exploratory laparotomy. Subjective assessment in DLG included weak lymphatic fluid drainage, lymphangiectasia, lymphatic reflux, fistula and thoracic outlet reflux or obstruction. While for CTL combined with DLG, the intestinal and extra-intestinal lesions were evaluated, including lymph node, edema, lymphangiectasia and abnormal distribution, fistula, and lymphangiomatosis. All the diagnosis was compared with intestinal endoscopy results. Results For DLG, 16 weak lymphatic fluid drainages, 9 lymphangiectasia, 1 fistula with abdomen and 14 thoracic outlets weak lymphatic fluid drainage or obstruction were found. For DLG combined with CTL, 16 intestinal lumens dilatation and 14 circumferential intestinal thickening were found in intestinal lesions. While for extra-intestinal lesions, the imaging features included edematous findings （12 in mesentery, 7 ascites only, 2 hydrothorax and ascites, and 3 pericardial, thoracic and abdominal effusions）, abdominal lymph nodes （6 cases）, lymphangiectasia and abnormal distributions （14 cases）, fistulas （lymph-intestinal luminal fistula in 4 cases, and lymph-abdominal fistula in 3 cases）, lymphangiomatosis （3 cases）, and thoracic duct outlet dysfunction and reflux （14 cases）.The number of cases diagnosed as intestinal lymphangiectasia, intestinal luminal lymph exudation and lymph fistula were 16, 10 and 6 with intestinal endoscopy, while the number were 11, 0, and 4 with CTL combination with DLG. Conclusion Combination of CTL with DLG is valuable in the diagnosis of PIL.

关 键 词：淋巴管扩张 肠 体层摄影术 X线计算机 淋巴造影术 内窥镜检查 消化系统 

分 类 号：R574.5[医药卫生—消化系统]