经淋巴结穿刺淋巴管造影并胸导管栓塞治疗乳糜漏  

Intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage

作　　者：刘超[1] 丁鹏绪[1] 袁锐[1] 王玲[1] 徐苗[1] 刘东雷[2] 赵高峰[2] 刘莹[3] 李宗明[1] 闫磊[1] 韩新巍[1] Liu Chao;Ding Pengxu;Yuan Rui;Wang Ling;Xu Miao;Liu Donglei;Zhao Gaofeng;Liu Ying;Li Zongming;Yan Lei;Han Xinwei(Department of Intervention Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Thoracic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Respiration,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院放射介入科,450052 [2]郑州大学第一附属医院胸外科,450052 [3]郑州大学第一附属医院呼吸科,450052

出　　处：《中华放射学杂志》2020年第11期1061-1065,共5页Chinese Journal of Radiology

摘　　要：目的探讨经淋巴结穿刺淋巴管造影并胸导管栓塞治疗乳糜漏的可行性与安全性。方法回顾性分析2019年7月至12月郑州大学第一附属医院收治的10例乳糜漏患者的临床资料。包括乳糜胸6例,乳糜腹1例,乳糜胸合并乳糜腹3例。所有患者均保守治疗失败。经淋巴结穿刺淋巴管造影明确乳糜池及胸导管位置后,经皮经腹穿刺乳糜池并引入微导管,胸导管造影显示漏口位置后使用弹簧圈联合组织胶进行栓塞。观察术后疗效和并发症发生情况。结果除1例患者淋巴管造影未能显示乳糜池和胸导管而未行胸导管栓塞外,其余患者淋巴管造影明确漏口位置后成功实施胸导管栓塞。8例患者经皮经腹腔穿刺乳糜池获得成功,1例患者多次穿刺失败后改行透视引导下逆向穿刺胸导管近心端并获得成功。8例患者术后3~7 d引流液完全消失,1例患者术后引流量显著减少至120 ml/d。仅1例患者术后腹腔少量出血,无特殊处理,所有患者均无严重并发症发生。结论经淋巴结穿刺淋巴管造影并胸导管栓塞治疗乳糜漏安全、有效且并发症少。Objective To evaluate the safety and feasibility of intranodal lymphangiography combined thoracic duct embolization in the treatment of chylous leakage.Methods The clinical data of ten patients with chylous leakage from July to December 2019 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.There were 6 cases of chylothorax,1 case of chylous ascites,and 3 cases of chylothorax combined with chylous ascites,respectively.Conservative treatment was invalid in all cases.The locations of cisterna chyli and thoracic duct were defined by percutaneous puncture intranodal lymphangiography.Then the percutaneous transabdominal puncture of cisterna chyli was performed and the microcatheter was inducted.The location of fistula was visualized by thoracic duct lymphangiography,and the embolization was performed by microcoils combined tissue adhesive agents.The post-operative curative effect and complications were recorded.Results One patient did not receive thoracic duct embolization because it was failed to visualize cisterna chyli by intranodal lymphatic angiography;thoracic duct embolization was successfully performed in the other 9 patients after chylous leakage fistula was located.Percutaneous transabdominal puncture of cisterna chyli was successfully accomplished in 8 patients.As for the other patient,after repeated failure of puncture,fluoroscopy-guided retrograde puncture at the proximal thoracic duct was performed successfully.After the operation,the drain output was completely disappeared within 3 to 7 days in 8 patients,and decreased down to 120 ml/d in 1 patient.Mild abdominal hemorrhage was found in 1 patient after thoracic duct embolization,without any treatment.No serious complications was found in all cases.Conclusion Intranodal lymphangiography and thoracic catheter embolization is safe and effective in the treatment of chylous leakage,with a low complication rate.

关 键 词：乳糜漏 淋巴管造影 乳糜池 胸导管 栓塞 

分 类 号：R65[医药卫生—外科学]