CT淋巴管成像在原发性小肠淋巴管扩张症中的诊断价值  

Application of CT lymphangiography in diagnosing primary intestinal lymphangiectasia

作　　者：赵晴晴 孙小丽 刘揆亮 彭亚辉[3] 沈文彬 王仁贵 ZHAO Qingqing;SUN Xiaoli;LIU Kuiliang;PENG Yahui;SHEN Wenbin;WANG Renguil(Department of Radiodogy,Peking Universiry Ninth School of Clinical Medicine,Beijing 100038,China;Department of Gastroenterology,Peking University Ninth School of Clinical Medicine,Beijing 100038,China;Beijing Jiaotong University,Beijing 100091,China;Department of Lymph Surgery,Peking University Ninth School of Clinical Medicine,Beijing 100038,China)

机构地区：[1]北京大学第九临床医学院放射科,北京100038 [2]北京大学第九临床医学院消化内科,北京100038 [3]北京交通大学,北京100091 [4]北京大学第九临床医学院淋巴外科,北京100038

出　　处：《实用放射学杂志》2020年第7期1069-1073,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(61876216);北京世纪坛医院院级课题(2018-q01)。

摘　　要：目的 探讨CT淋巴管成像(CTL)在小肠淋巴管扩张症(PIL)中的诊断价值.方法 回顾性分析经临床和/或病理确诊为PIL的患者64例,所有患者均行CTL及小肠胶囊内镜检查.根据PIL的内镜表现分型:Ⅰ型,表现为绒毛肿胀、扩张,偶见点状、短棒状不明显白斑样变;Ⅱ型,表现为散在点片状黄白色淋巴管扩张,累及范围多<2个1/3肠段;Ⅲ型,表现为明显的片状及鱼鳞状黄白色改变,弥漫分布,常同时累及全部小肠.PIL的CTL评价指标包括:(1)小肠肠壁增厚;(2)腹部淋巴管扩张及分布异常;(3)胸部淋巴管扩张及分布异常;(4)水肿样病变;(5)颈部和胸导管末端异常对比剂分布等.按胶囊内镜分型分为3组,将各组CTL表现进行统计学分析,P<0.05差异有统计学意义.结果 64例患者胶囊内镜检查表现为Ⅰ型17例、Ⅱ型34例和Ⅲ型13例.肠壁增厚Ⅰ型16例(94.12%),Ⅱ型24例(70.59%),Ⅲ型8例(61.54%);肠壁及肠系膜对比剂异常分布分别为Ⅰ型2例(11.76%),Ⅱ型17例(50%),Ⅲ型3例(23.08%),差异有统计学意义(P=0.016);腹腔对比剂异常分布Ⅰ型1例(5.88%),Ⅱ型13例(38.24%),Ⅲ型3例(23.08%),差异有统计学意义(P=0.041);腹腔积液Ⅰ型13例(76.47%),Ⅱ型18例(52.94%),Ⅲ型10例(76.92%).结论PIL的胶囊内镜分型反映了肠腔黏膜区域受累的病变程度和范围,CTL系统地显示全身淋巴管是否异常和存在回流异常,二者表现为一定程度相关性,对于明确PIL的定性和定位诊断、精确判断病变程度和累及范围等具有重要价值,进一步指导PIL的治疗.0bjective To explore the clinical value of CT lympbangingmaply(CTL)in dingnosing prinary inestinal lpmpnaictsin(PIL).Methods 64 patients dingnosed as PII.einicnlly and/or pathologically were analyzed retspeetively.All patients underwent CTL snd capule endewopy(CE).Three types o PIL.were oberwd with CE:type I,atypical enlarged ilicaonally acompnied bya few spols or rod like white patches;type Ⅱ typical lymphoid dilatation,often inobved one or 1wo segments of intestine;type I,ifued ypcal lympheid dilatation with yllowish white sale appearance,uwully inolved the whole itestine.CTl.sss ineluded:(1)thickening of the intestinal wall;(2) labnormal lymphuntie vesse dilntation and distriburion in abdomen;(3)abnormal lymphatie vessels dilatation and distibution in chesi;(4)edenatous lesions;(5)abnormal distribution of contrast agent around meck and thoracie dust ends.Patients were divided in 3 groups acoedig to the thre types digosed with CE.CTL.charcerisis were amalyzed beween different groups.Results CE in 64 patients showed 17 cases of type 1,34 ceesof type Ⅱ and 13 cases of type Ⅱ,The intestinal wall thickening were showed in 16 cases(94.12%)of type I,24 ease(70.59%)of lype I and 8 cases(61.54%)of type M.Abnormal distribution of comtrast agent in intestinal wall and mentery were showed in2 cass(11.76%)of type 1,17 cases(50%) of type Ⅲ and 3 cases(21.08%) of type I atype Ⅱ was more sigmificant than 1 and Ⅲ(P=0.016).Abormal dstributions of contrast agent in abdominal cavity were showed in1 case(5.88%)oftype I。13 ca8es(38.24%)of Iype I and 3 cases(23.08%) oftype 1,ype Ⅱ wa more significant than I and Ⅲ(P=0.041).Ascie were showed in 13 cases(76.47%)of type 1,18 cases(52.949%)of type I and 10 cases 176.92%1 of Iype a.Concluston CE easidiaionon of PIL.rles the degree and exent of lesions involved in the mucosal area of the intestiheand CTL shows the sbnormity and abrormsl rellux of lymphatie vsselcCombined disgnosis with CE and CTL.can proride locational,quantitative and qualitative eraluation of PIL,and fu

关 键 词：原发性小肠淋巴管扩张症 胶囊内镜 计算机体层成像 淋巴管成像 

分 类 号：R574.5[医药卫生—消化系统] R814.42[医药卫生—内科学]