超声在核素淋巴显像左颈静脉角浓聚原因待查中的应用  

The Application of Ultrasound in Detecting the Cause of Activity in Left Jugular Venous Angle in Lymphoscintigraphy

作　　者：文哲 童冠圣 赵晓宁 王萤萤 易梅 刘勇 Wen Zhe;Tong Guansheng;Zhao Xiaoning;Wang Yingying;Yi Mei;Liu Yong(Department of Nuclear Medicine,Beiing Shiitan Hospital,Capital Medical University,Beijing 100038,China;Department of Ultrasound,Beiing Shiitan 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(北京大学第九临床医学院)核医学科,北京市100038 [2]首都医科大学附属北京世纪坛医院(北京大学第九临床医学院)超声科,北京市100038

出　　处：《中国超声医学杂志》2021年第4期386-390,共5页Chinese Journal of Ultrasound in Medicine

基　　金：北京市医院管理中心“扬帆”计划2021年度临床技术创新项目(No.XMLX202113);北京市科委首都临床诊疗技术研究及示范应用(No.Z191100006619051);中国国家铁路集团有限公司科技研究开发计划项目(No.J2019Z604);首都医科大学附属北京世纪坛医院淋巴外科开放课题专项基金(No.2019-LB03)

摘　　要：目的评价超声在核素淋巴显像中左颈静脉角浓聚(ALJVA)病因识别中的临床价值。方法回顾性收集行经双下肢核素淋巴显像受检者751例,其中ALJVA共232例(30.9%),将103例临床及超声影像资料完整的受检者纳入研究,男36例,女67例;年龄16~78岁,平均(48±16)岁。根据临床诊断分析ALJVA的病因学构成情况,应用超声进行影像学分型;以临床问卷方式评估超声在ALJVA诊疗中的应用价值。结果入组ALJVA 103例受检者中最终临床诊断最常见的三种依次为:肢体或躯干淋巴水肿(42.7%,44/103)、蛋白丢失性肠病(15.5%,16/103)、非创伤性乳糜积液(11.7%,12/103)。88%(91/103)的ALJVA受检者左静脉角区高频超声检查结果异常,最常见的为胸导管出口梗阻性病变,包括外压狭窄27例、弥漫性狭窄33例、末端膜状梗阻17例、末端栓塞6例、左颈静脉-胸导管反流8例。10例颈静脉角区检出转移性淋巴结,6例发现锁骨下静脉或头臂静脉血栓,6例检出颈静脉高压征象。临床问卷调查结果显示,超声检查可帮助85%的ALJVA受检者制订下一步诊疗方案,对于末端膜状梗阻型,超声可更好地直接提示病因(P<0.05),对于弥漫狭窄型及正常型,超声可更好地间接帮助制订诊疗方案(P<0.05)。结论超声在ALJVA病因识别中具有较高的临床价值,可协助临床制定进一步的诊疗方案。Objective To evaluate the clinical value of ultrasound in identifying the cause of focal activity in left jugular venous angle in lymphoscintigraphy(ALJVA). Methods A total of 751 patients who underwent isotope lymphoscintigraphy in Beijing Shijitan Hospital were collected, including 232 cases(30.9%) of ALJVA. 103 patients with complete clinical and ultrasound imaging data were included in the study, including 36 males and 67 females. According to the clinical diagnosis and analysis of the etiological composition of ALJVA, ultrasound was used for image classification;clinical questionnaire was used to evaluate the application value of ultrasound in the diagnosis and treatment of ALJVA. Results In 103 patients with ALJVA, the three most common clinical diagnoses were limb or trunk lymphedema(42.7%, 44/103), protein loss enteropathy(15.5%, 16/103) and non-traumatic chylous effusion(11.7%, 12/103). Eighty-eight percent(91/103) of patients with ALJVA had abnormal left venous angle ultrasound examination results, and the most common ones were thoracic duct outlet obstruction, including external pressure stenosis in 27 cases, diffuse stenosis in 33 cases, terminal membranous obstruction in 17 cases, terminal embolism in 6 cases, and left jugular vein-thoracic duct reflux in 8 cases. Metastatic lymph nodes were found around jugular vein in 10 cases, subclavian vein and/or brachiocephalic vein thrombosis in 6 cases, and jugular vein hypertension in 6 cases. The results of questionnaire survey show that ultrasound examination can help 85% of ALJVA patients make the next diagnosis and treatment plan, terminal diaphragm obstruction ultrasound can better directly prompt the cause of disease(P<0.05), diffuse stenosis ultrasound and normal ultrasound can better indirectly help make the diagnosis and treatment plan(P<0.05). Conclusions Ultrasound has a high clinical value in the etiology identification of ALJVA, which can assist the clinical diagnosis and treatment.

关 键 词：胸导管 颈 静脉角 超声 核素淋巴显像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R551.2[医药卫生—诊断学]