目的 探讨下肢淋巴显像对淋巴水肿为首发症状的淋巴结恶性肿瘤的诊断价值。方法 回顾性分析21例以下肢淋巴水肿为首发症状的淋巴结恶性肿瘤患者的淋巴显像结果。显像方法：于患者双足第1、2趾间皮下缓慢注射99Tcm-右旋糖酐(99TcmO4-DX)，注射后10min和1h，3h，6h分别行从足到头的全身动态显像，重点观察淋巴回流中断部位及淋巴结显影特征。结果21例患者均经淋巴结穿刺活检或淋巴结切除术，病理证实不显影的淋巴结均出现不同程度的恶性肿瘤浸润，转移癌18例，非霍奇金淋巴瘤3例。淋巴动态显像主要表现：下肢主淋巴管显影增宽，可伴有侧枝淋巴管显影；下肢、腰臀部、盆腹壁、会阴部不同程度的皮下淋巴返流；腹股沟、髂、腰不同部位的淋巴管显影中断，相应部位淋巴结不显影。结论99TcmO4-DX淋巴显像能准确发现下肢淋巴回流情况和病变淋巴结部位，对以下肢淋巴水肿为首发症状的淋巴结恶性肿瘤患者病因诊断有重要意义。

Objective To Investigate the diagnostic value of 99Tcm-DX lymphoscintigraphy in lower limbs lymphedema as the initial symptom of lymphnode malignant tumor. Methods Twenty-one lymph node malignant tumor patients initially diagnosed as lymphedema were studied retrospectively. After the injection of 99Tcm-DX into the first interdigital space of both feet, lymphoscintigraphy was performed at 10 min, 1, 3 and 6 hour intermittently. Results Lymphoscintigrams were analyzed for visualization of lymphatics and lymph nodes, dermal backflow of radiotracers in all bodies. The main characteristics included the lymphatic blockage，lateral branch lymphatic，dermal backflow，non-imaging lymph nodes. Conclusion As a noninvasive, accurate and effective imaging modality, lymphangioscintigraphy may be the first choice for evaluating lower limbs lymphedema as the initial symptom of lymphnode malignant tumor.