摘要
目的探讨淋巴管肌瘤病(LAM)合并乳糜性胸、腹腔积液的影像学表现。方法回顾性分析20例合并乳糜性胸、腹腔积液的LAM患者的直接淋巴管造影(DLG)及CT资料,其中15例行胸导管探查,18例行手术治疗。结果 20例LAM均合并不同程度的乳糜性胸腔积液,其中8例合并乳糜性腹腔积液。DLG显示20例LAM腹膜后及髂淋巴管均不同程度扩张,并5例向对侧返流。DLG直观显示14例胸导管出口受阻,其中13例行胸导管探查证实梗阻存在,并行胸导管梗阻解除术,1例胸、腹腔积液完全消失,12例减少或趋于稳定。6例胸导管部分于DLG未见明确显示,其中2例为胸导管结扎术后,1例行髂外淋巴管静脉吻合术后腹腔积液好转;其余4例中2例行胸导管探查证实出口受阻,行胸导管出口梗阻解除术后胸、腹腔积液减少;另2例未行胸导管探查,行髂外或下肢淋巴管静脉吻合术后腹腔积液减少。结论 DLG及CT成像可为LAM合并乳糜性胸、腹腔积液的诊断及治疗提供重要信息。
Objective To explore the imaging findings of lymphangioleiomyomatosis（LAM） accompanied with celiac hydrothorax and ascites.Methods The direct lymphangiography（DLG） and CT imaging findings of 20 patients with LAM accompanied by celiac hydrothorax and ascites were retrospectively analyzed,in which 15 LAM underwent thoracic duct exploration and 18 underwent operation.Results CT showed 20 LAM combining with celiac pleural effusion,accompanied by 8 with ascites.DLG showed all of the 20 LAM iliac and /or retroperitoneal lymphatic vessels were dilated.5 cases refluxed to contralateral iliac and /or retroperitoneal lymphatic.14 thoracic duct occluded were intuitively seen by DLG,in which obstructions were confirmed by thoracic duct exploration and received relieving obstruction operation in 13 cases,hydrothorax and ascites were disappeared in 1 case,and decreased or stabilized in 12 cases.6 thoracic ducts from lumbar vertebra 5 to thoracic vertebra 8 were not seen by DLG,and 2 thoracic duct obstruction were confirmed by thoracic duct exploration,in which 1 was operated by external iliac lymphatic vein anastomosis and ascites improved.2 of the other 4 LAM were confirmed with thoracic duct occlusion by thoracic duct exploration,the hydrothorax and ascites were diminuted with obstruction removing,the other 2 cases did not received horacic duct exploration and performed with external iliac or lower limb lymphatic vein anastomosis and ascites improved.Conclusion DLG and CT can provide important information for diagnosis and therapy of LAM accompanied by celiac hydrothorax and ascites.
出处
《临床放射学杂志》
CSCD
北大核心
2012年第11期1563-1566,共4页
Journal of Clinical Radiology
