原发性面部淋巴水肿淋巴干病变的研究分析  

The clinical value of lymphatic trunk lesions in primary facial lymphedema

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] 苏万春 沈文彬[1] Xin Jianfeng;Sun Yuguang;Xia Song;Chang Kun;Zhu Yan;Liu Xin;An Ran;Su Wanchun;Shen Wenbin(Department of Lymphatic Surgery,Affiliated Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

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：《中华整形外科杂志》2019年第8期772-778,共7页Chinese Journal of Plastic Surgery

基　　金：北京市医管局科研培育计划(PX2019027)

摘　　要：目的探讨原发性面部淋巴水肿淋巴干病变的影像学特点及病因。方法对首都医科大学附属北京世纪坛医院2015年1月至2017年10月收治的26例原发性面部淋巴水肿患者的临床资料进行回顾性分析,其中男13例,女13例,年龄(21.8±13.9)岁,右侧面部肿胀6例,左侧面部肿胀14例,双侧面部肿胀6例,共32侧。总结胸导管和右淋巴导管磁共振成像的影像学特点,并与术中探查结果进行对比。结果26例原发性面部淋巴水肿患者磁共振淋巴导管成像共32侧,其中胸导管20侧,右淋巴导管12侧。胸导管磁共振成像可见颈段胸导管有扩张(13侧)和纤细(7侧)2种异常表现,右淋巴导管可见3种异常表现:扩张(6侧)、纤细(4侧)和未见明确管径结构(2侧)。手术探查发现颈段胸导管和右淋巴导管存在结构异常,其原因包括:周围纤维组织的包裹(30侧),颈内静脉血管鞘的包裹(11侧),颈横静脉的压迫(5侧)及自身发育异常(2侧)。结论胸导管和右淋巴导管磁共振成像可以作为一项有效诊断原发性面部淋巴水肿的影像学方法,颈段胸导管、右淋巴导管的结构异常可能是原发性面部淋巴水肿的致病因素之一。Objective To investigate the imaging features and etiology of lymphatic trunk in primary facial lymphedema.Methods 26 patients with primary facial lymphedema patients(F/M,13/13,ages 21.8±13.9 years old)were recruited from January 2015 to October 2017 in this study,with 32 sides facial lymphedema reported,including 6 right facial lymphedema,14 left facial lymphedema,and 6 bilateral facial lymphedema.And all the patient data and imaging were retrospective analysis to summarize the MR imaging features of thoracic duct and right lymphatic duct,meanwhile compared with surgical results.Results For all 26 patients,MR imaging result in thoracic duct manifests 32 lymphatic duct,including 20 thoracic duct and 12 right lymphatic duct.The imaging features demonstrate two typical findings:dilated(13 cases)and slim(7 cases)demonstrations.While for right lymphatic duct,the MR result included three types:dilated(6 cases),slim(4 cases)and no sign of manifestations(2 cases).In surgery,the thoracic duct in cervical segment demonstrated abnormal structures,including capsulated by fibrous tissues in peripheral area(30 sides),surrounded by internal jugular vein sheath(11 sides),external pressed by venae cervicalis transversa(5 sides)and lymphatic trunk dysplasia(2 sides).Conclusions MR thoracic duct and right lymphatic duct imaging can be used as an effective diagnostic imaging method for primary facial lymphedema,and the structural anomaly of the upper cervical catheter and the right lymphatic catheter may be one of the pathogenic factors of primary facial lymphedema.

关 键 词：淋巴水肿 面部 胸导管 右淋巴导管 磁共振成像 

分 类 号：R73[医药卫生—肿瘤]