直接淋巴管造影后CT淋巴管成像在原发性小肠淋巴管扩张症中的诊断价值

Diagnostic Value of Direct Lymphangiography Followed by CT Lymphangiography in Primary Intestinal Lymphangiectasia

目的探讨直接淋巴管造影后CT淋巴管成像(CTL)在原发性小肠淋巴管扩张症(PIL)中的诊断价值。方法回顾性搜集经手术病理和/或小肠内镜证实的PIL患者55例,所有患者均行直接淋巴管造影后腹盆部、胸部及颈部MSCT检查。CTL中肠系膜、肠壁、腹膜后和/或腹腔其他脏器有对比剂异常分布者为阳性组,以上部位均无对比剂异常分布为阴性组,对两组间各指标进行统计学分析,分类变量采用χ^(2)检验,P﹤0.05为差异有统计学意义。CTL统计指标包括:肠腔瘘、腹腔瘘、对侧腰干反流、骶前反流、腰大肌周围反流、胸部对比剂异常分布、颈部对比剂异常分布、小肠肠壁增厚、肠系膜水肿、肠系膜淋巴结增大、浆膜腔积液等。结果阳性组中肠腔瘘、腹腔瘘、对侧腰干反流、骶前反流、腰大肌周围反流发生率明显高于阴性组(P=0.045、0.045、0.047、0.000、0.002),而肠系膜水肿、肠系膜淋巴结增大发生率明显低于阴性组(P=0.023、0.007),差异有统计学意义。结论CTL中对比剂在肠系膜、肠壁、腹膜后及腹腔脏器的异常分布是PIL的重要表现,提示腹部淋巴管的异常分布、范围及严重程度,为PIL的诊治及术前评估提供影像依据。

Objective To investigate the diagnostic value of direct lymphangiography followed by CT lymphangiography(CTL)in primary intestinal lymphangiectasia(PIL).Methods Fifty-five patients with PIL confirmed by surgical pathology and/or endoscopy were retrospectively collected,and all patients underwent direct lymphangiography followed by abdominopelvic,thoracic and cervical MSCT.Those with abnormal distribution of contrast agent in the mesentery,intestinal wall,retroperitoneum and/or other organs of the abdominal cavity in CTL were considered as positive group,and those without abnormal distribution of contrast agent in the above parts were considered as negative group.The difference was statistically significant at P﹤0.05 when compared between the two groups and analyzed byχ^(2)test.The statistical indexes of CTL included:intestinal fistula,abdominal fistula,contralateral lumbar stem reflux,presacral reflux,periaqueductal reflux,abnormal distribution of contrast agent in the chest,abnormal distribution of contrast agent in the neck,intestinal wall thickening in the small intestine,mesenteric edema,enlarged mesenteric lymph nodes,and plasma cavity effusion.Results The incidence of enterocutaneous fistula,ventral fistula,contralateral lumbar trunk reflux,presacral reflux,and periaqueductal reflux was significantly higher in the positive group than in the negative group(P=0.045,0.045,0.047,0.000,0.002),while the incidence of mesenteric edema and mesenteric lymph node enlargement was significantly lower than in the negative group(P=0.023,0.007),with statistically significant differences.Conclusion The abnormal distribution of contrast in the mesentery,intestinal wall,retroperitoneum and abdominal organs in CTL is an important manifestation of PIL,suggesting the abnormal distribution,extent and severity of abdominal lymphatics,and providing an imaging basis for the diagnosis and treatment of PIL and preoperative evaluation.