下肢淋巴显像诊断乳糜反流性淋巴水肿

Lower limb lymphoscintigraphy in diagnosis of chylous reflux lymphedema

目的探讨双侧＋单侧下肢淋巴显像诊断乳糜反流性淋巴水肿的价值。方法回顾分析56例临床诊断为乳糜反流性淋巴水肿患者的显像结果。双下肢显像于患者双足第1、2及4、5趾间皮下缓慢注射^99 Tc^m-右旋糖酐（^99 Tc^mDX）,分别于10min、1、3、6h行从足到头的全身动态显像,观察患者双下肢淋巴管、双腹股沟、髂、腰淋巴结、胸导管及静脉角的显影情况;间隔1-7天后,于健侧足部第1、2及4、5趾间皮下缓慢注射^99 Tc^m-DX,重点观察患侧下肢是否有显像剂出现。结果双下肢淋巴显像显示56例患者（58侧患肢）中,48侧（48/58,82.76%）患肢淋巴管结构异常;38侧（38/58,65.52%）肢体腹股沟、髂、腰淋巴结显影数量减少或未显影;34例（34/56,60.71%）左静脉角显影出现不同程度的梗阻征象。单侧下肢显像显示58侧患肢经对侧注药后,反流部位均可见不同程度的显像剂出现。结论双侧＋单侧下肢淋巴显像可以直接、无创且动态显示乳糜反流。

Objective To explore the diagnostic value of bilateral and unilateral lower limb lymphoscintigraphy in the diagnosis of chylous reflux lymphedema.Methods The imaging data of 56 patients with lower limb chylous reflux of lymphedema were studied retrospectively.All patients underwent bilateral and unilateral lower limb lymphoscintigraphy.After injection of ^99 Tc^m-DX into the first and last interdigital spaces of both feet,lymphoscintigraphy from foot to head was performed at 10 min,1,3and 6hintermittently.Lymphoscintigrams were analyzed for visualization lymphatics,lymph nodes,thoracic duct and angulus venosus of radiotracers in all bodies.After 1—7days,^99 Tc^m-DX was injected into the normal feet and the patients were underwent lymphoscintigraphy as the same method.Whether the imaging agent appeared on contralateral abnormal lower limbs was observed.Results Bilateral lower limb lymphoscintigraphy showed that 48（48/58,82.76%）lymphatic vessel structure were dysplastic,38（38/58,65.52%）lower limb lymph nodes were decreased or not visible and 34（34/56,60.71%）left thoracic duck obstructions were found.Unilateral lower limb lymphoscintigraphy showed 56 patients with 58 of lower limb chylous reflux of lymphedema.Conclusion Bilateral and unilateral lower limb lymphoscintigraphy can directly,non-invasively and dynamically discover lymphatic system abnormality.