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目的探讨影像学检查在胸导管末端探查术治疗淋巴管肌瘤病(LAM)合并乳糜胸术式选择中的诊断价值。方法回顾性分析经临床和/或病理证实的34例LAM合并乳糜胸患者的临床和影像学资料。所有患者均接受放射性核素99 Tcm-右旋糖酐(DX)淋巴显像和CT淋巴管造影(CTL)检查。根据99 Tcm-DX淋巴显像对胸导管分型:Ⅰ型为异常浓聚型;Ⅱ型为异位引流型;Ⅲ型为未显影或一过性显影型,Ⅰ型和Ⅱ型为胸导管异常。根据CTL对胸导管分型:Ⅰ型为扩张型;Ⅱ型为末端梗阻型;Ⅲ型为主干缩窄型;Ⅳ型为异位引流型;Ⅴ型为未显示型。以Ⅰ~Ⅳ型为胸导管异常。评价2种方法显示胸导管病变的一致性。结果99 Tcm-DX淋巴显像显示Ⅰ型17例,Ⅱ型3例,Ⅲ型14例。58.82%(20/34)的LAM合并乳糜胸病例存在胸导管病变。CTL显示Ⅰ型15例,Ⅱ型3例,Ⅲ型5例,Ⅳ型2例,Ⅴ型9例,73.53%(25/34)的LAM合并乳糜胸病例存在胸导管病变。2种方法显示胸导管是否存在病变的一致性较好(Kappa=0.679)。CTL胸导管分型中,Ⅰ型和Ⅱ型多采用胸导管—静脉吻合术或胸导管末端松解术解除梗阻,Ⅲ型多采用胸导管末端压迫带/粘连松解术解除梗阻,Ⅳ型根据胸导管异常回流路径来选择手术入路和手术方式,Ⅴ型多采取保守治疗。结论 CTL优于99 Tcm-DX淋巴显像,能准确显示胸导管的病变情况,为胸导管末端探查术治疗LAM合并乳糜胸的术式选择提供影像学依据。
Objective To investigate the diagnostic value of imaging examination in the treatment of lymphangiomyosarcoma (LAM) complicated with chylothorax by thoracic terminal exploration. Methods The clinical and imaging data of 34 patients with LAM combined with chylothorax clinically and / or pathologically confirmed retrospectively were retrospectively analyzed. All patients underwent radionuclide 99 Tcm-dextran (DX) lymphography and CT lymphangiography (CTL). According to 99Tcm-DX lymphatic imaging of the thoracic duct type: type I was abnormal concentration; type II is the type of ectopic drainage; type III was undeveloped or transient development type, type I and type II for the thoracic duct abnormal. According to CTL classification of the thoracic duct: type I for the dilatation; type Ⅱ for the terminal obstruction; type Ⅲ for the main narrowed type; type Ⅳ for the heterotopic drainage type; type Ⅴ is not shown. Ⅰ ~ Ⅳ type of thoracic duct abnormalities. Evaluation 2 methods show the consistency of thoracic duct disease. Results 99 Tcm-DX lymphoscintigraphy showed 17 cases of type Ⅰ, 3 cases of type Ⅱ and 14 cases of type Ⅲ. 58.82% (20/34) cases of LAM with chylothorax thoracic duct disease. CTL showed thoracic duct disease in 15 cases of type Ⅰ, 3 cases of type Ⅱ, 5 cases of type Ⅲ, 2 cases of type Ⅳ, 9 cases of typeⅤ, and 73.53% (25/34) of LAM with chylothora. Two methods showed good consistency of the thoracic duct (Kappa = 0.679). CTL thoracic duct type, type Ⅰ and type Ⅱ use thoracic catheter - venous anastomosis or thoracic end-tube lymphadenectomy to relieve obstruction, type Ⅲ multi-thoracic duct distal compression band / adhesiolysis to relieve obstruction, type Ⅳ according to Thoracic duct abnormal return path to choose the surgical approach and surgical approach, type Ⅴ take conservative treatment. Conclusion CTL is better than 99 Tcm-DX lymphoscintigraphy, which can accurately show the pathological changes of thoracic duct, and provide imaging evidence for surgical selection of LAM combined with chylothorax for thoracic duct endoscopy.