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目的应用超声检测小肠淋巴管扩张症(IL)患者颈段胸导管病变,探讨颈段胸导管病变类型与IL相关性。方法入选60例经内镜或活检病理确诊为IL的患者作为研究对象。入选者同期行同位素99 Tcm-DX淋巴显像及颈部高频超声,对比两种方法的影像学特征并进行分型比较。结果 IL患者高频超声颈段胸导管显像可分为5型:I型,正常型(13例);Ⅱ型:弥漫缩窄型(10例);Ⅲ型:末端梗阻型(28例);Ⅳ型:血栓型(3例);Ⅴ型:反流型(6例),胸导管异常检出比例高达78.3%。IL患者同位素99 Tcm淋巴显像可以分为:异常浓聚型(36例)、异位引流型(8例)、未显影或一过性显影型(16例),胸导管异常检出比例达73.6%。两种检测方法检出胸导管异常比较无统计学意义(P>0.05)。14例患者行胸导管末端探查成形术(8例行胸导管黏连松解术,6例行胸导管-静脉吻合术),术中所见与超声提示的淋巴回流障碍情况一致,术后所有患者淋巴回流障碍症状较前明显改善。结论超声检测颈段胸导管病变与IL具有相关性,IL的发病原因可能是继发于颈段胸导管回流的全身性淋巴回流障碍。
Objective To detect the cervical thoracic duct disease in patients with intestinal lymphatic dilatation (IL) by ultrasonography and to explore the correlation between the type of thoracic duct disease and IL. Methods Sixty patients who were diagnosed as IL by endoscopy or biopsy were enrolled in this study. In the same period, 99Tcm-DX lymphoscintigraphy and neck high-frequency ultrasonography were performed. The imaging characteristics of the two methods were compared and classified. Results The high-frequency ultrasound thoracic duct imaging in IL patients was classified into 5 types: type I, normal type (13 cases), type II: diffuse constriction type (10 cases), type III: terminal obstruction type (28 cases) ; Type Ⅳ: thrombosis (3 cases); type V: reflux (6 cases), the detection rate of thoracic duct abnormalities was as high as 78.3%. The isotope 99 Tcm lymphoscintigraphy of IL patients can be divided into abnormal concentration type (36 cases), ectopic drainage type (8 cases), undeveloped or transient imaging type (16 cases), and the detection rate of thoracic duct abnormalities is up to 73.6%. There was no significant difference between the two methods in detecting abnormal thoracic duct (P> 0.05). Twenty-four patients underwent thoracic catheter end exploration angioplasty (8 underwent thoracic catheter adhesions lysis and 6 underwent thoracic catheter-venous anastomosis). The findings of the surgery were consistent with those of ultrasound-indicated lymphatic drainage disorders. All postoperative Patients with lymphatic symptoms were significantly improved. Conclusion Ultrasound detection of cervical thoracic duct disease and IL has a correlation, the pathogenesis of IL may be secondary to cervical thoracic duct reflux of the generalized lymphatic flow disorders.