计算机断层扫描淋巴管造影技术在猫乳糜胸诊疗中的应用

doi:10.11843/j.issn.0366-6964.2024.11.010

摘要/Abstract

摘要：

乳糜胸是由不同病因导致胸导管破裂或阻塞，继而引起乳糜进入胸腔的疾病，保守治疗失败时通常需要手术干预。鉴于不同猫的胸导管解剖结构差异大，在胸导管结扎前对猫胸导管及其分支进行造影成像是外科计划中必不可少的辅助手段。随着计算机断层扫描(computed tomography，CT)成像技术在犬猫淋巴管造影中的逐步应用，各种CT淋巴管造影方法被提出。本文汇总了目前猫乳糜胸诊疗中的CT淋巴管造影方案，以供临床参考。

关键词: 猫, 计算机断层扫描, 淋巴管造影, 乳糜胸

Abstract:

Chylothorax is a condition in which a rupture or obstruction of the thoracic duct is caused by a different etiology, which subsequently leads to the entry of coeliac into the thoracic cavity. Surgical intervention is usually required when conservative treatment fails. Because thoracic duct anatomy varies widely in different cats, contrast imaging of thoracic duct branches prior to ligation thoracic duct is an essential step in surgical planning. With the gradual application of computerized tomography (CT) imaging technology in canine and feline lymphangiography, a variety of minimally invasive preoperative CT lymphangiography methods have been proposed. This article summarizes the current CT lymphangiography protocols in the diagnosis and treatment of feline chylothorax for clinical reference.

Key words: cat, computed tomography, lymphangiography, chylothorax

中图分类号:

康博, 郭瑞泽, 张迪. 计算机断层扫描淋巴管造影技术在猫乳糜胸诊疗中的应用[J]. 畜牧兽医学报, 2024, 55(11): 4890-4899.

Bo KANG, Ruize GUO, Di ZHANG. Application of Computed Tomography Lymphangiography in Diagnosis and Treatment of Cat Chylothorax[J]. Acta Veterinaria et Zootechnica Sinica, 2024, 55(11): 4890-4899.

图/表 8

图 1

图 2

图 3

图 4

图 5

表 1

犬猫CT淋巴管造影方法比较"

名称 Name	引导方法 Method of guidance	造影剂种类/(I，mg·mL^–1) Types of contrast agent	造影剂剂量/(mL·kg^–1) Dose of contrast agent	注射位点 Injection points	扫描时间/min Scan time
开腹直视下经肠系膜淋巴管注射CT淋巴管造影 CT lymphangiography via mesenteric lymphatic capillary injection under laparotomy	开腹直视 Laparotomy	碘海醇300 Iohexol 300	犬1 猫1 Canine 1 Feline 1	肠系膜淋巴管 Mesenteric lymphatic capillary	立即 Immediately
超声引导下经肠系膜淋巴结注射CT淋巴管造影 CT lymphangiography via mesenteric lymph node under ultrasound guided	超声 Ultrasound	碘海醇300 Iohexol 300	犬1.5~2 mL·只^-1 猫1.5 mL·只^-1 Canine 1.5~2 mL a dog Feline 1.5 mL a cat	肠系膜淋巴结 Mesenteric lymph node	犬2、5 猫3、6 Canine 2，5 Feline 3，6
经肛周皮下注射CT淋巴管造影 Perianal hypodermic CT lymphangiography	无 None	碘帕醇370 Iopamidol 370	犬0.6 猫1.2~1.8 Canine 0.6 Feline 1.2~1.8	肛周分点注射 Perianal fractional injection	犬5、10 猫5、10、15 Canine 5，10 Feline 5，10, 15
超声引导下经腘淋巴结注射CT淋巴管造影 CT lymphangiography via popliteal lymph node injection under ultrasound guided	超声 Ultrasound	碘海醇350 Iohexol 350	犬0.17~1 猫1.5 Canine 0.17~1 Feline 1.5	单侧腘淋巴结 Unilateral popliteal lymph node	犬3、6、9、12 猫3、5、7 Canine 3, 6, 9, 12 Feline 3, 5, 7
经跖骨背侧皮下注射CT淋巴管造影 Transmetatarsal dorsal hypodermic CT lymphangiography	无 None	碘海醇300 Iohexol 300	犬0.75~1 Canine 0.75~1	单侧跖骨背侧皮下 Unilateral transmetatarsal dorsal hypodermic	犬3、5、7 Canine 3, 5, 7
经跖垫内注射CT淋巴管造影 CT lymphangiography via intraplantar pad injection	无 None	碘海醇350 Iohexol 350	犬1 猫1 Canine 1 Feline 1	双后肢跖垫内 Intraplantar pad of both hindlimbs	犬5、8、11、14 猫3、6、9、12 Canine 5, 8, 11, 14 Feline 3, 6, 9, 12
超声引导下经皮肝脏穿刺注射CT淋巴管造影 CT lymphangiography via percutaneous hepatic puncture injection under ultrasound guided	超声 Ultrasound	碘帕醇370 Iopamidol 370	猫1~1.5 Feline 1~1.5	肝右内叶或肝左内叶 Right inner lobe of the liver or left inner lobe of the liver	猫5、10、15 Feline 5, 10, 15

表 1

图 6

图 7

参考文献 43

1	SINGH A , BRISSON B , NYKAMP S . Idiopathic chylothorax: pathophysiology, diagnosis, and thoracic duct imaging[J]. Compend Contin Educ Vet, 2012, 34 (8): E1- E8.
2	BIRCHARD S J , FOSSUM T W . Chylothorax in the dog and cat[J]. Vet Clin North Am Small Anim Pract, 1987, 17 (2): 271- 283. doi: 10.1016/S0195-5616(87)50027-4
3	FOSSUM T W . Chylothorax in cats: is there a role for surgery?[J]. J Feline Med Surg, 2001, 3 (2): 73- 79. doi: 10.1053/jfms.2001.0113
4	FORRESTER S D , FOSSUM T W , ROGERS K S . Diagnosis and treatment of chylothorax associated with lymphoblastic lymphosarcoma in four cats[J]. J Am Vet Med Assoc, 1991, 198 (2): 291- 294. doi: 10.2460/javma.1991.198.02.291
5	CôTÉ E , MANNING A M , EMERSON D , et al. Assessment of the prevalence of heart murmurs in overtly healthy cats[J]. J Am Vet Med Assoc, 2004, 225 (3): 384- 388. doi: 10.2460/javma.2004.225.384
6	KARP S I , FREEMAN L M , RUSH J E , et al. Dilated cardiomyopathy in cats: survey of veterinary cardiologists and retrospective evaluation of a possible association with diet[J]. J Vet Cardiol, 2022, 39, 22- 34. doi: 10.1016/j.jvc.2021.11.002
7	LUIS FUENTES V , ABBOTT J , CHETBOUL V , et al. ACVIM consensus statement guidelines for the classification, diagnosis, and management of cardiomyopathies in cats[J]. J Vet Intern Med, 2020, 34 (3): 1062- 1077. doi: 10.1111/jvim.15745
8	FABRIZIO F , CALAM A E , DOBSON J M , et al. Feline mediastinal lymphoma: a retrospective study of signalment, retroviral status, response to chemotherapy and prognostic indicators[J]. J Feline Med Surg, 2014, 16 (8): 637- 644. doi: 10.1177/1098612X13516621
9	DAY M J . Review of thymic pathology in 30 cats and 36 dogs[J]. J Small Anim Pract, 1997, 38 (9): 393- 403. doi: 10.1111/j.1748-5827.1997.tb03492.x
10	KUTARA K , MOCHIZUKI Y , OHNISHI A , et al. The outcome and CT findings of low-dose intensity modulated radiation therapy with SQAP in a cat with thymoma[J]. Vet Sci, 2020, 7 (4): 203. doi: 10.3390/vetsci7040203
11	ZITZ J C , BIRCHARD S J , COUTO G C , et al. Results of excision of thymoma in cats and dogs: 20 cases (1984-2005)[J]. J Am Vet Med Assoc, 2008, 232 (8): 1186- 1192. doi: 10.2460/javma.232.8.1186
12	NOACK S , HARRINGTON J , CARITHERS D S , et al. Heartworm disease-Overview, intervention, and industry perspective[J]. Int J Parasitol Drugs Drug Resist, 2021, 16, 65- 89. doi: 10.1016/j.ijpddr.2021.03.004
13	TRZIL J E . Feline asthma: diagnostic and treatment update[J]. Vet Clin North Am Small Anim Pract, 2020, 50 (2): 375- 391. doi: 10.1016/j.cvsm.2019.10.002
14	BOWMAN D D , ATKINS C E . Heartworm biology, treatment, and control[J]. Vet Clin North Am Small Anim Pract, 2009, 39 (6): 1127- 1158. doi: 10.1016/j.cvsm.2009.06.003
15	THRALL D E. Textbook of veterinary diagnostic radiology[M]. 6th ed. St. Louis: Elsevier, 2013: 574-577.
16	FOSSUM T W , JACOBS R M , BIRCHARD S J . Evaluation of cholesterol and triglyceride concentrations in differentiating chylous and nonchylous pleural effusions in dogs and cats[J]. J Am Vet Med Assoc, 1986, 188 (1): 49- 51.
17	KAGAN K G , BREZNOCK E M . Variations in the canine thoracic duct system and the effects of surgical occlusion demonstrated by rapid aqueous lymphography, using an intestinal lymphatic trunk[J]. Am J Vet Res, 1979, 40 (7): 948- 958.
18	MILLWARD I R , KIRBERGER R M , THOMPSON P N . Comparative popliteal and mesenteric computed tomography lymphangiography of the canine thoracic duct[J]. Vet Radiol Ultrasound, 2011, 52 (3): 295- 301. doi: 10.1111/j.1740-8261.2010.01790.x
19	FOSSUM T W , MERTENS M M , MILLER M W , et al. Thoracic duct ligation and pericardectomy for treatment of idiopathic chylothorax[J]. J Vet Intern Med, 2004, 18 (3): 307- 310. doi: 10.1111/j.1939-1676.2004.tb02550.x
20	JOHNSON E G , WISNER E R , KYLES A , et al. Computed tomographic lymphography of the thoracic duct by mesenteric lymph node injection[J]. Vet Surg, 2009, 38 (3): 361- 367. doi: 10.1111/j.1532-950X.2008.00473.x
21	KIM M , LEE H , LEE N , et al. Ultrasound-guided mesenteric lymph node iohexol injection for thoracic duct computed tomographic lymphography in cats[J]. Vet Radiol Ultrasound, 2011, 52 (3): 302- 305. doi: 10.1111/j.1740-8261.2010.01794.x
22	ANDO K , KAMIJYOU K , HATINODA K , et al. Computed tomography and radiographic lymphography of the thoracic duct by subcutaneous or submucosal injection[J]. J Vet Med Sci, 2012, 74 (1): 135- 140. doi: 10.1292/jvms.11-0214
23	IWANAGA T , TOKUNAGA S , MOMOI Y . Thoracic duct lymphography by subcutaneous contrast agent injection in a dog with chylothorax[J]. Open Vet J, 2016, 6 (3): 238- 241. doi: 10.4314/ovj.v6i3.13
24	KIM K , CHOEN S , HWANG J , et al. CT Lymphangiography with contrast medium injection into the perianal subcutaneous region in a dog with chylothorax[J]. J Vet Clin, 2018, 35 (6): 299- 301. doi: 10.17555/jvc.2018.12.35.6.299
25	KAMIJO K , KANAI E , OISHI M , et al. Perirectal injection of imaging materials for computed tomographic lymphography and near infrared fluorescent thoracoscopy in cats[J]. Vet Med, 2019, 64 (8): 342- 347. doi: 10.17221/32/2019-VETMED
26	NAGANOBU K , OHIGASHI Y , AKIYOSHI T , et al. Lymphography of the thoracic duct by percutaneous injection of iohexol into the popliteal lymph node of dogs: experimental study and clinical application[J]. Vet Surg, 2006, 35 (4): 377- 381. doi: 10.1111/j.1532-950X.2006.00160.x
27	SINGH A , BRISSON B A , NYKAMP S , et al. Comparison of computed tomographic and radiographic popliteal lymphangiography in normal dogs[J]. Vet Surg, 2011, 40 (6): 762- 767. doi: 10.1111/j.1532-950X.2011.00860.x
28	CHUN H , CHO H , CHEON H , et al. Determination of optimal dosage and delay time for computed tomographic lymphography after percutaneous injection of Iohexol into popliteal lymph nodes in dogs[J]. J Vet Med Sci, 2009, 71 (7): 873- 878. doi: 10.1292/jvms.71.873
29	LEE N , WON S , CHOI M , et al. CT thoracic duct lymphography in cats by popliteal lymph node iohexol injection[J]. Vet Radiol Ultrasound, 2012, 53 (2): 174- 180. doi: 10.1111/j.1740-8261.2011.01892.x
30	KIM K , CHEON S , KANG K , et al. Computed tomographic lymphangiography of the thoracic duct by subcutaneous iohexol injection into the metatarsal region[J]. Vet Surg, 2020, 49 (1): 180- 186. doi: 10.1111/vsu.13324
31	LIN L S , CHIU H C , NISHIMURA R , et al. Computed tomographic lymphangiography via intra-metatarsal pad injection is feasible in dogs with chylothorax[J]. Vet Radiol Ultrasound, 2020, 61 (4): 435- 443. doi: 10.1111/vru.12865
32	CHIANG C , CHEN K S , CHIU H C , et al. Computed tomography lymphangiography via intrametatarsal pad injection is feasible in cats with chylothorax[J]. Am J Vet Res, 2021, 83 (2): 133- 139.
33	JOHNSON E G , MAYHEW P D , RUNGE J J . Computed tomographic lymphangiography following percutaneous intrahepatic injection of iopamidol in cats[J]. Am J Vet Res, 2023, 84 (2): ajvr.22.08.0147.
34	夏维木, 苏红专. 淋巴管造影术对乳糜尿的诊断和治疗进展[J]. 东南国防医药, 2015, 17 (5): 524- 525. doi: 10.3969/j.issn.1672-271X.2015.05.024
	XIA W M , SU H Z . Progress in diagnosis and treatment of chyluria by lymphangiography[J]. Military Medical Journal of Southeast China, 2015, 17 (5): 524- 525. doi: 10.3969/j.issn.1672-271X.2015.05.024
35	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[J]. 临床放射学杂志, 2012, 31 (1): 65- 69.
	ZHANG J M , CHEN X B , ZHAO T , et al. The imaging manifestations of direct lymphangiography and CT findings after lymphangiography of intestinal lymphangiectasia[J]. Journal of Clinical Radiology, 2012, 31 (1): 65- 69.
36	张奇瑾, 王仁贵, 张春燕, 等. CT淋巴管造影对淋巴管肌瘤病乳糜胸的诊断价值[J]. CT理论与应用研究, 2016, 25 (2): 211- 217.
	ZHANG Q J , WANG R G , ZHANG C Y , et al. The diagnostic value of CT lymphangiography about chylothorax of lymphangioleiomyomatosis[J]. CT Theory Appl, 2016, 25 (2): 211- 217.
37	刘定益, 夏维木, 唐崎, 等. 足背淋巴管造影在乳糜漏定位诊断和治疗中的应用[J]. 中华外科杂志, 2016, 54 (4): 281- 285. doi: 10.3760/cma.j.issn.0529-5815.2016.04.008
	LIU D Y , XIA W M , TANG Q , et al. Application of lymphography in the location and treatment decision of chyle leakage: an analysis of 177 cases[J]. Chinese Journal of Surgery, 2016, 54 (4): 281- 285. doi: 10.3760/cma.j.issn.0529-5815.2016.04.008
38	董健, 信建峰, 霍萌, 等. 直接淋巴管造影与CT淋巴管成像在继发性小肠淋巴管扩张症的回顾性研究[J]. 临床放射学杂志, 2018, 37 (3): 419- 423.
	DONG J , XIN J F , HUO M , et al. Direct lymphangiography with sequential CT lymphangiography in secondary intestinal lymphangiectasia: a retrospective study[J]. Journal of Clinical Radiology, 2018, 37 (3): 419- 423.
39	RANDALL E K , JONES M D , KRAFT S L , et al. The development of an indirect computed tomography lymphography protocol for sentinel lymph node detection in head and neck cancer and comparison to other sentinel lymph node mapping techniques[J]. Vet Comp Oncol, 2020, 18 (4): 634- 644. doi: 10.1111/vco.12585
40	PATSIKAS M N , PAPADOPOULOU P L , CHARITANTI A , et al. Computed tomography and radiographic indirect lymphography for visualization of mammary lymphatic vessels and the sentinel lymph node in normal cats[J]. Vet Radiol Ultrasound, 2010, 51 (3): 299- 304. doi: 10.1111/j.1740-8261.2009.01657.x
41	舒易来, 吴海涛. CT间接淋巴造影定位前哨淋巴结[J]. 中国眼耳鼻喉科杂志, 2009, 9 (5): 333- 334. doi: 10.3969/j.issn.1671-2420.2009.05.037
	SHU Y L , WU H T . Sentinel lymph nodes were located by CT indirect lymphography[J]. Chinese Journal of Ophthalmology and Otorhinolaryngology, 2009, 9 (5): 333- 334. doi: 10.3969/j.issn.1671-2420.2009.05.037
42	DE BONIS A , COLLIVIGNARELLI F , PAOLINI A , et al. Sentinel lymph node mapping with indirect lymphangiography for canine mast cell tumour[J]. Vet Sci, 2022, 9 (9): 484. doi: 10.3390/vetsci9090484
43	CHITI L E , GARIBOLDI E M , STEFANELLO D , et al. Sentinel lymph node mapping and biopsy in cats with solid malignancies: an explorative study[J]. Animals (Basel), 2022, 12 (22): 3116.

[1]	郑焕琴, 姜晓敏, 岳红, 王宝岩, 刘洋, 张兴晓, 张建龙, 朱洪伟. 猫1型疱疹病毒分离鉴定及部分生物学特性分析[J]. 畜牧兽医学报, 2024, 55(7): 3040-3048.
[2]	孙凡媛, 刘怡婷, 郭昕怡, 陈建材, 周华波, 覃一峰, 欧阳康, 韦祖樟, 黄伟坚, 陈樱. 猫上呼吸道疾病的病原、诊断与防治[J]. 畜牧兽医学报, 2024, 55(6): 2345-2356.
[3]	周宁, 汤承, 许佳, 岳华, 陈曦. 猫泛白细胞减少症病毒A91S变异株对猫的致病性及基因组特征研究[J]. 畜牧兽医学报, 2024, 55(6): 2560-2568.
[4]	李春晓, 安尉, 高博泉, 王振龙, 韩冰, 陶慧, 王金全, 王秀敏. 猫犬主要过敏原蛋白的最新研究进展[J]. 畜牧兽医学报, 2024, 55(2): 471-480.
[5]	刘福康, 袁莉刚, 张达, 汤傲星, 刘光清, 朱杰. 猫传染性腹膜炎病毒N蛋白表达及其多克隆抗体制备[J]. 畜牧兽医学报, 2024, 55(10): 4773-4778.
[6]	范小雨, 米洁, 刘佳琦, 菅玉双, 李四豪, 范云鹏, 刘迎秋, 宋晓平, 张为民, 麻武仁. 回阳九针术对母猫绝育术后苏醒监测指标的影响[J]. 畜牧兽医学报, 2024, 55(1): 365-372.
[7]	王莹, 李佳康, 曾悦, 史开拓, 韦丽婷, 彭佳佳, 李秋燕, 曹龙龙, 周登元. 猫杯状病毒单克隆抗体的制备[J]. 畜牧兽医学报, 2024, 55(1): 401-405.
[8]	眭玉珍, 陈桂珍, 左守军, 汪海东, 宋鹏涛, 栗亮亮, 张龙现, 董海聚, 刘芳. 河南省宠物猫华支睾吸虫和其他肠道寄生虫感染状况分析[J]. 畜牧兽医学报, 2023, 54(7): 3022-3030.
[9]	胥辉豪, 冯雪倩, 朴雪玲, 慎晓军, 郑小波, 杨恒, 林珈好, 金艺鹏, 林德贵. 猫角膜缘干细胞不同采集、分离与培养鉴定方法的对比研究[J]. 畜牧兽医学报, 2023, 54(7): 3091-3101.
[10]	李昭燕, 高江, 郭时惠, 赵茹茜, 马文强. 猫过敏原检测方法与控制措施的研究进展[J]. 畜牧兽医学报, 2023, 54(6): 2272-2279.
[11]	李蔚, 张强, 瞿嘉豪, 吴亚平, 胡若辰, 贾若艺, 郭如海, 马清义, 潘广林, 王兴龙. 大熊猫肠道菌群年龄演替规律分析[J]. 畜牧兽医学报, 2023, 54(6): 2619-2630.
[12]	许鑫燕, 郑亚婷, 刘迪, 马波, 刘家森, 曲连东. 一株猫疱疹病毒Ⅰ型的分离与鉴定[J]. 畜牧兽医学报, 2023, 54(4): 1713-1720.
[13]	张海洋, 朱秋祥, 高志诚, 贾坤, 王京煜, 冀锦朝, 梁雾滢, 莫睿文, 李守军. 猫急性应激模型的建立及诊断标志物的筛选[J]. 畜牧兽医学报, 2023, 54(3): 1249-1260.
[14]	闫朗, 李馨秋, 郜平平, 姜婉璐, 张迪. 猫瘙痒性皮肤病病例临床特征与治疗效果回顾性分析[J]. 畜牧兽医学报, 2023, 54(3): 1325-1332.
[15]	乔康佳, 袁占奎, 王佳尧, 石磊, 王虓, 张彬. 基于CT技术评估髌骨内脱犬骨骼畸形[J]. 畜牧兽医学报, 2023, 54(2): 816-824.