直接淋巴管造影后MSCT诊断乳糜胸

Post direct lymphangiography MSCT in diagnosis of chylothorax

目的探讨直接淋巴管造影(DLG)后MSCT诊断乳糜胸的价值。方法回顾性分析30例乳糜胸患者的DLG及DLG后MSCT成像资料,将MSCT与DLG影像相对照。结果 DLG后MSCT显示造影侧髂及腹膜后淋巴管扩张、纡曲30例(100%),与DLG相吻合;出现对侧髂腰部反流和腹膜后淋巴管扩张13例(43.33%),DLG显示9例(30.00%,P=0.13);出现腹腔反流4例(13.33%),DLG显示3例(10.00%,P=1.00);胸导管出口受阻20例(66.67%),DLG显示22例(73.33%,P=0.50);胸导管部分未显影9例(30.00%),DLG显示8例(26.67%,P=1.00);对比剂入血10例(33.33%),DLG显示4例(13.33%,P=0.07);对比剂漏出至胸腔8例(26.67%),DLG显示1例(3.33%,P=0.02)。两种检查均显示1例(3.33%)肺内淋巴管扩张(P=1.00)。结论 DLG后MSCT成像与DLG互为补充,可为乳糜胸的诊断及治疗提供重要依据。

Objective To explore the application value of MSCT after direct lymphangiography（DLG） in diagnosis of chylothorax.Methods DLG and postprocedure MSCT imaging of 30 patients with chylothorax were retrospectively analyzed and compared.Results DLG and postprocedure MSCT imaging showed dilated iliac and retroperitoneal lymphatic vessel circuitous in all 30 cases（100%）.Reflux to contralateral iliac and retroperitoneal lymphatic vessel was demonstrated on postlymphatic MSCT in 13 cases（43.33%）,while in 9 cases（30.00%） on DLG（P=0.13）.Abdominal reflux was detected in 4 cases（13.33%） by postlymphatic MSCT and 3（10.00%） by DLG（P=1.00）.Postprocedure MSCT showed 20 patients（66.67%） with thoracic duct occlusion,while DLG showed 22（73.33%,P=0.50）.Nine patients（30.00%） with partial thoracic ducts were demonstrated on postprocedure MSCT,while 8（26.67%） were demonstrated on DLG（P=1.00）.Ten（33.33%） and 4（13.33%） cases of contrast medium entering blood were demonstrated on postlymphatic MSCT and DLG,respectively（P=0.07）.Postlymphatic MSCT showed 8（26.67%） hydrothorax chyle leak,whereas DLG detected 1（3.33%,P=0.02）.One（3.33%） lymph vessel dilatation was detected simultaneously by MSCT and DLG（P=1.00）.Conclusion DLG and postlymphatic MSCT are complementary,therefore providing essential information of diagnosis and therapy for chylothorax.