CAJ | 학술논문

目的探讨直接淋巴管造影对胸导管出口梗阻的诊断价值.方法回顾性分析124例临床表现为淋巴水肿、乳糜胸、乳糜腹、乳糜尿和小肠淋巴管扩张症等患者的直接淋巴管造影资料,并与颈部胸导管手术探查结果进行对照分析直接淋巴管造影对颈段胸导管的显示与胸导管手术探查情况进行对照,2名影像科医师在不知胸导管手术探查结果的情况下,阅读直接淋巴管造影后DSA造影结果,对手术侧颈干、锁骨下干、支气管纵隔干和胸导管末端入血梗阻的数值差异用Kappa值进行一致性分析.结果 124例中,直接淋巴管造影显示淋巴反流:左颈干80例,左锁骨下干75例,左支气管纵隔干30例.胸导管出口入血障碍118例,与颈部胸导管手术探查结果对比分析,符合率分别为89.9％(80/89)、92.6％(75/81)、90.9％ (30/33)和95.2％(118/124).直接淋巴管造影对颈段胸导管的显示与探查情况进行对照,2名影像科医师阅读直接淋巴管造影后DSA造影结果具有高度一致性(K=0.82,P＜0.05).另外,直接淋巴管造影显示腰干以下淋巴管不同程度迂曲、扩张和结构紊乱者114例(91.9％),无异常者仅10例(8.1％)；乳糜池以下不同程度反流者92例(74.2％)；肠干反流者16例(12.9％)；向肾区反流者11例(8.9％)；向心包反流者5例(4.0％).伴有阴道淋巴漏7例(5.6％),腹膜后淋巴漏2例(1.6％),胸腔淋巴漏3例(2.4％),气管淋巴漏1例(0.8％).结论直接淋巴管造影与颈部胸导管手术探查在显示胸导管出口梗阻的各种征象方面具有较高的一致性,直接淋巴管造影可作为胸导管末段手术探查的重要依据.
목적 탐토직접림파관조영대흉도관출구경조적진단개치.방법 회고성분석124례림상표현위림파수종、유미흉、유미복、유미뇨화소장림파관확장증등환자적직접림파관조영자료,병여경부흉도관수술탐사결과진행대조분석직접림파관조영대경단흉도관적현시여흉도관수술탐사정황진행대조,2명영상과의사재불지흉도관수술탐사결과적정황하,열독직접림파관조영후DSA조영결과,대수술측경간、쇄골하간、지기관종격간화흉도관말단입혈경조적수치차이용Kappa치진행일치성분석.결과 124례중,직접림파관조영현시림파반류:좌경간80례,좌쇄골하간75례,좌지기관종격간30례.흉도관출구입혈장애118례,여경부흉도관수술탐사결과대비분석,부합솔분별위89.9％(80/89)、92.6％(75/81)、90.9％ (30/33)화95.2％(118/124).직접림파관조영대경단흉도관적현시여탐사정황진행대조,2명영상과의사열독직접림파관조영후DSA조영결과구유고도일치성(K=0.82,P＜0.05).령외,직접림파관조영현시요간이하림파관불동정도우곡、확장화결구문란자114례(91.9％),무이상자부10례(8.1％)；유미지이하불동정도반류자92례(74.2％)；장간반류자16례(12.9％)；향신구반류자11례(8.9％)；향심포반류자5례(4.0％).반유음도림파루7례(5.6％),복막후림파루2례(1.6％),흉강림파루3례(2.4％),기관림파루1례(0.8％).결론 직접림파관조영여경부흉도관수술탐사재현시흉도관출구경조적각충정상방면구유교고적일치성,직접림파관조영가작위흉도관말단수술탐사적중요의거.
Objective To investigate the diagnostic values of direct lymphangiography for the thoracic duct outlet obstruction.Methods The image data of direct lymphangiography were retrospectively analyzed in 124 patients with lymphedema,Chylothorax,chylous ascites,chyluria and intestinal lymphangiectasis,and compared with the results of neck thoracic duct surgical exploration,2 radiologists reviewed DLG DSA images in a double blind manner.The number of neck stem,subclavian stem,bronchialmediastinal stem and TD terminal into blood obstruction on the operation side showed by DLG were assessed using Kappa analysis.Results Of 124 patients,80 patients had the left cervical lymphatic stem reflux on DLG,75 patients with the left subclavian lymphatic stem reflux,30 patients with the left bronchial-mediastinal lymphatie stem reflux,118 patients showed the thoracic duct outlet barrier into the blood.The consistency rate of DLG were 89.9％ (80/89),92.6％ (75/81),90.9％ (30/33) and 95.2％ (118/124) compared with the neck thoracic duct surgical exploration.Tow radiologists had a high degree of diagnostic consistency (K =0.82,P ＜ 0.05).In addition,114 patients (91.9％) had tortuous,dilated waist lymphatic stem,only 10 patients (8.1％) were normal.The cisterna chyli reflux were found in 92 patients (74.2％),intestinal stem reflux in 16 patients (12.9％),reflux to the kidney area in 11 patients (8.9％),to the pericardium reflux in 5 patients (4.0％),vaginal lymphatic leakage in 7 patients (5.6％),retroperitoneal lymph leakage in 2 patients (1.6％),pleural lymphatic leakage in 3 patients (2.4％),tracheal lymph leakage in 1 patient (0.8％).Conclusion Direct lymphangiography has a high consistency with the cervical thoracic duct surgical exploration in displaying thoracic duct outlet obstruction.