直接淋巴管造影术后CT对继发性小肠淋巴管扩张症的初步探讨
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摘要
目的探讨直接淋巴管造影术后CT对继发性小肠淋巴管扩张症的诊断价值。方法回顾性分析我院自2007年4月至2012年5月共收治的14例继发性小肠淋巴管扩张症患者的直接淋巴管造影术后CT资料,并与手术及胃肠镜或胶囊内镜所见进行对照分析。结果肠管不同程度扩张14例;肠壁增厚14例;肠腔液体CT值为3～12 HU,平均约7.1 HU;腹腔积液并肠系膜水肿11例;肠系膜结节9例。肠淋巴干返流8例;腹膜后或胸壁淋巴管扩张、增生及返流14例。结论直接淋巴管造影术后CT可显示继发性小肠淋巴管扩张症其肠道及肠道以外的淋巴管病变范围和程度,并可同时显示其继发病的部位、范围及程度,为临床治疗和预后提供依据。
Objective To explore the value of CT scanning followed direct lymphangiography(DLG)in displaying secondary intestinal lymphangiectasia.Methods 14 patients with secondary intestinal lymphangiectasia from April 2007 to May 2012 were collected.The CT images followed DLG were retrospective analyzed,and compared with operation,enteroscopy or capsule endoscopy findings.Results CT showed various degrees of intestinal canal dilation in 14 cases;thickening of bowel wall in 14 cases;the CT value of the intestinal cavity liquid was 3~12 HU(average 7.1 HU);ascites and mesenteric edema in 11 cases;mesenteric nodule in 9 cases.CT followed DLG showed intestinal lymphatic trunk reflux in 8 cases;retroperitoneal or pleural lymphatic dilation,hyperplasia and reflux in 14 cases.Conclusion CT followed DLG can display the range and degree of the intestinal tract,outside lesions of secondary intestinal lymphangiectasia,and can display the site,range and degree of the deuteropathy,which provides the basis for the clinical treatment and prognosis.
Objective To explore the value of CT scanning followed direct lymphangiography(DLG)in displaying secondary intestinal lymphangiectasia.Methods 14 patients with secondary intestinal lymphangiectasia from April 2007 to May 2012 were collected.The CT images followed DLG were retrospective analyzed,and compared with operation,enteroscopy or capsule endoscopy findings.Results CT showed various degrees of intestinal canal dilation in 14 cases;thickening of bowel wall in 14 cases;the CT value of the intestinal cavity liquid was 3~12 HU(average 7.1 HU);ascites and mesenteric edema in 11 cases;mesenteric nodule in 9 cases.CT followed DLG showed intestinal lymphatic trunk reflux in 8 cases;retroperitoneal or pleural lymphatic dilation,hyperplasia and reflux in 14 cases.Conclusion CT followed DLG can display the range and degree of the intestinal tract,outside lesions of secondary intestinal lymphangiectasia,and can display the site,range and degree of the deuteropathy,which provides the basis for the clinical treatment and prognosis.
引文
1 Waldmann TA,Steinfeld JL,Dutcher TF,et al.The role of the gastro-intestinal system in'idiopathic hypoproteinemia'.Gastroenterology,1961,41:197
2 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldma-nn's disease).Orphanet J Rare Dis,2008,3:5
3 Cammarota G,Cianci R,Gasbarrini G.High-resolution magnifyingvideo endoscopy in primary intestinal lymphangiectasia:a new rolefor endoscopy?Endoscopy,2005,37:607
4 Strober W,Wochner RD,Carbone PP,et al.Intestinal lymphangiecta-sia:a protein-losing enteropathy with hypogammaglobulinemia,lym-phocytopenia and impaired homograft rejection.J Clin Invest,1967,46:1643
5 Wen J,Tang Q,Wu J,et al.Primary intestinal lymphangiectasia:fourcase reports and a review of the literature.Dig Dis Sci,2010,55:3466
6 Fang YH,Zhang BL,Wu JG,et al.A primary intestinal lymphangiec-tasia patient diagnosed by capsule endoscopy and confirmed at sur-gery:a case report.World J Gastroenterol,2007,13:2263
7张洋,吴晓荫.肝硬化继发小肠淋巴管扩张症一例报告.实用临床医学,2007,8:58
8李国栋,朱晚林.继发性小肠淋巴管扩张症临床分析.全科医学临床与教育,2012,10:336
9 James S,Balfe DM,Lee DKT,et al.Small-Bowel disease:Categoriza-tion by CT Examination.AJR,1987,148:863
10林香春,吴静,高炳霞,等.小肠淋巴管扩张症合并病毒性肝炎2例.世界华人消化杂志,2008,16:2195
11 Stevens RL,Jones B,Fishman EK.The CT halo sign:a new findingin intestinal lymphangiectasia.J Comput Assist Tomogr,1997,21:1005
12 Macari M,Emil J,Balthazar EJ.CT of Bowel Wall Thickening:Sig-ni?cance and Pitfalls of Interpretation.AJR,2001,176:1105
13 Gore RM,Balthazar EJ,Ghahremani GG,et al.CT features of ulcera-tive colitis and crohn's disease.AJR,1996,167:3
14张建梅,陈孝柏,赵桐,等.小肠淋巴管扩张症在直接淋巴管造影及造影后CT平扫中的影像表现.临床放射学杂志,2012,31:65
15 Keberle M,Mork H,Jenett M,et al.Computed tomography after lym-phangiography in the diagnosis of intestinal lymphangiectasia withprotein-losing enteropathy in Noonan's syndrome.Eur Radiol,2000,10:1591
16 Vignes S,Bellanger J.Videocap sule endoscopy as a useful tool todiagnose primary intestinal lymphangiectasia.Rev Med Interne,2007,28:173
17 Bliss CM,Schroy III PC.Primary intestinal lymphangiectasia.CurrTreat Options Gastroenterol,2004,7:3
18 Mazzie JP,Maslin PI,Moy L,et al.Congenital intestinal lymphangi-ectasia:CT demonstration in a young child.Clin Imaging,2003,27:330
2 Vignes S,Bellanger J.Primary intestinal lymphangiectasia(Waldma-nn's disease).Orphanet J Rare Dis,2008,3:5
3 Cammarota G,Cianci R,Gasbarrini G.High-resolution magnifyingvideo endoscopy in primary intestinal lymphangiectasia:a new rolefor endoscopy?Endoscopy,2005,37:607
4 Strober W,Wochner RD,Carbone PP,et al.Intestinal lymphangiecta-sia:a protein-losing enteropathy with hypogammaglobulinemia,lym-phocytopenia and impaired homograft rejection.J Clin Invest,1967,46:1643
5 Wen J,Tang Q,Wu J,et al.Primary intestinal lymphangiectasia:fourcase reports and a review of the literature.Dig Dis Sci,2010,55:3466
6 Fang YH,Zhang BL,Wu JG,et al.A primary intestinal lymphangiec-tasia patient diagnosed by capsule endoscopy and confirmed at sur-gery:a case report.World J Gastroenterol,2007,13:2263
7张洋,吴晓荫.肝硬化继发小肠淋巴管扩张症一例报告.实用临床医学,2007,8:58
8李国栋,朱晚林.继发性小肠淋巴管扩张症临床分析.全科医学临床与教育,2012,10:336
9 James S,Balfe DM,Lee DKT,et al.Small-Bowel disease:Categoriza-tion by CT Examination.AJR,1987,148:863
10林香春,吴静,高炳霞,等.小肠淋巴管扩张症合并病毒性肝炎2例.世界华人消化杂志,2008,16:2195
11 Stevens RL,Jones B,Fishman EK.The CT halo sign:a new findingin intestinal lymphangiectasia.J Comput Assist Tomogr,1997,21:1005
12 Macari M,Emil J,Balthazar EJ.CT of Bowel Wall Thickening:Sig-ni?cance and Pitfalls of Interpretation.AJR,2001,176:1105
13 Gore RM,Balthazar EJ,Ghahremani GG,et al.CT features of ulcera-tive colitis and crohn's disease.AJR,1996,167:3
14张建梅,陈孝柏,赵桐,等.小肠淋巴管扩张症在直接淋巴管造影及造影后CT平扫中的影像表现.临床放射学杂志,2012,31:65
15 Keberle M,Mork H,Jenett M,et al.Computed tomography after lym-phangiography in the diagnosis of intestinal lymphangiectasia withprotein-losing enteropathy in Noonan's syndrome.Eur Radiol,2000,10:1591
16 Vignes S,Bellanger J.Videocap sule endoscopy as a useful tool todiagnose primary intestinal lymphangiectasia.Rev Med Interne,2007,28:173
17 Bliss CM,Schroy III PC.Primary intestinal lymphangiectasia.CurrTreat Options Gastroenterol,2004,7:3
18 Mazzie JP,Maslin PI,Moy L,et al.Congenital intestinal lymphangi-ectasia:CT demonstration in a young child.Clin Imaging,2003,27:330