CAJ | 학술논문

目的分析妇科肿瘤治疗后淋巴水肿患者淋巴显像的影像特点,建立评估下肢淋巴系统损伤的方法.方法 166例连续性病例(332个肢体)双足第1,2趾间皮下注射99Tcm-DX 111～185 MBq(0.1～0.15 ml)后行淋巴显像.根据显像结果,以淋巴管完整程度和淋巴皮下返流状况为指标,将下肢淋巴系统损伤分为0,1,2和3级.根据国际淋巴学会淋巴水肿临床分期标准,将淋巴水肿分为0,I,Ⅱa,Ⅱb和Ⅲ期.列联表χ2检验比较2种分类方法间的相关关系.χ2检验分析淋巴系统损伤分级的临床特征.结果妇科肿瘤治疗后患者淋巴显像表现包括:下肢、盆腔和腹腔区域的淋巴管中断、皮下淋巴返流、淋巴管和淋巴结不显影、淋巴囊肿和淋巴瘘等.332个肢体,水肿分期为0,Ⅰ,Ⅱa,Ⅱb和Ⅲ期的分别为65(19.6%),71(21.4%),131(39.5%),62(18.7%)和3(0.9%)个,淋巴显像损伤分级为0,1,2和3级的数量分别为36(10.8%),79(23.8%),116(34.9%)和101(30.4%)个.统计学分析表明,2者间有良好的相关性(χ2=313.483,P<0.001).临床分析表明,2和3级损伤所占比例放疗组高于非放疗组,分别为70.5%(158/224)和54.6%(59/108),χ2=9.662,P=0.022;有丹毒病史者3级损伤比例也高于无丹毒者,分别为73.1%(38/52)和43.9%(50/144),χ2=12.238,P<0.001.随着淋巴水肿病程进展,3级损伤肢体数所占百分比逐渐增高、病程<1.5年者为36.6%(34/93),病程1.5～5年者为72.3%(34/47),病程>5年者为76.9%(20/26)(χ2=23.123,P<0.001).不同类型妇科肿瘤(χ2=4.000,P=0.676)、是否化疗(χ2=0.411,P=0.938)对淋巴系统损伤分级无明显影响.结论淋巴显像损伤分级方法有助于评估妇科肿瘤治疗后患者的淋巴系统损伤程度,可为治疗后淋巴水肿的临床诊断和预防提供客观依据.
목적 분석부과종류치료후림파수종환자림파현상적영상특점,건립평고하지림파계통손상적방법.방법 166례련속성병례(332개지체)쌍족제1,2지간피하주사99Tcm-DX 111～185 MBq(0.1～0.15 ml)후행림파현상.근거현상결과,이림파관완정정도화림파피하반류상황위지표,장하지림파계통손상분위0,1,2화3급.근거국제림파학회림파수종림상분기표준,장림파수종분위0,I,Ⅱa,Ⅱb화Ⅲ기.렬련표χ2검험비교2충분류방법 간적상관관계.χ2검험분석림파계통손상분급적림상특정.결과 부과종류치료후환자림파현상표현포괄:하지、분강화복강구역적림파관중단、피하림파반류、림파관화림파결불현영、림파낭종화림파루등.332개지체,수종분기위0,Ⅰ,Ⅱa,Ⅱb화Ⅲ기적분별위65(19.6%),71(21.4%),131(39.5%),62(18.7%)화3(0.9%)개,림파현상손상분급위0,1,2화3급적수량분별위36(10.8%),79(23.8%),116(34.9%)화101(30.4%)개.통계학분석표명,2자간유량호적상관성(χ2=313.483,P<0.001).림상분석표명,2화3급손상소점비례방료조고우비방료조,분별위70.5%(158/224)화54.6%(59/108),χ2=9.662,P=0.022;유단독병사자3급손상비례야고우무단독자,분별위73.1%(38/52)화43.9%(50/144),χ2=12.238,P<0.001.수착림파수종병정진전,3급손상지체수소점백분비축점증고、병정<1.5년자위36.6%(34/93),병정1.5～5년자위72.3%(34/47),병정>5년자위76.9%(20/26)(χ2=23.123,P<0.001).불동류형부과종류(χ2=4.000,P=0.676)、시부화료(χ2=0.411,P=0.938)대림파계통손상분급무명현영향.결론 림파현상손상분급방법 유조우평고부과종류치료후환자적림파계통손상정도,가위치료후림파수종적림상진단화예방제공객관의거.
Objective To evaluate the lymphoscintigraphic imaging characteristics for the patients with lower limb lymphedema and to establish a novel grading system for the injury to lower limb lymphatic system. Methods One hundred and sixty six consecutive patients (332 lower limbs) with lower limb lymphedema after surgical and(or) radiotherapy treatment for gynecological cancer were recruited into this retrospective study. The lymphoscintigraphy studies were performed after subcutaneous injection of 111～185 MBq (0. 1～0. 15 ml) of 99Tcm-DX into the webbed space between the first and second toes of both feet. Based on the integrity of lymphatic vessel and the extension of dermal diffusion on lymphoscintigram,the lymphatic injury to the lower limb was graded as 0, 1,2 and 3 respectively. The lymphedema of the limb was staged as 0, Ⅰ , Ⅱ a, Ⅱ b, Ⅲ by the standard of Consensus Document of the International Society of Lymphology (ISL). Chi square test was carried out to validate the established grading system for the assessment of the injury to the lower limb lymphatic system. Results The lymphoscintigraphic imaging characteristics included lymphatic blockage, dermal backflow, no visualization of lymphatic or lymph node, lymphocele and lymph fistula in the lower limb, pelvis and abdomen. There were 65 (19.6%), 71 (21.4%),131 (39.5%), 62 (18.7%) and 3 (0.9%) limbs staged as 0, Ⅰ , Ⅱa, Ⅱb, and Ⅲ for lymphedema while 36(10.8%), 79(23.8%), 116(34.9%) and 101 (30.4%) limbs graded as 0, 1, 2, and 3 for lymphatic injury. There was a statistically significant correlation between the grading methods (χ2 =313.483, P <0.001). The patients who underwent radiotherapy had a higher incidence rate of grade 2 and 3 (70.5%, 158/224) than those who underwent surgery (53.6%, 59/108) (χ2 = 9.662, P = 0.022).The patients with erysipelas had a higher incidence rate of grade 3(73.1%, 38/52) than those without erysipelas (43.9%, 50/114) (χ2= 12.238, P<0.001). The incidence rate of grade 3 increased with the duration of lymphedema after treatment: 36.6% (34/93) for less than 1.5 years, 72.3% (34/47) for between 1.5 to 5 years, and 76.9% (20/26) for more than 5 years (χ2 = 23.123, P<0.001). The grade of lymphatic injury showed no significant difference among 3 types of gynecological cancers (χ2 = 4.000, P =0.676), or between the patients with and without chemotherapy (χ2 =0.411, P=0.938). Conclusions Lymphoscintigraphy is a reliable modality to diagnose lower limb lymphedema after treatment for gynecological cancer. The injury grading system could provide objective assessment of the lymphatic damage.