Kos Sebastian, Haueisen Harald, Lachmund Ulrich, Roeren Thomas
Institute of Radiology, Kantonsspital Aarau, 5001 Aarau, Switzerland.
Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):968-73. doi: 10.1007/s00270-007-9026-5.
Since the advent of computed tomography, numbers and expertise in Lymphangiography (LAG) have markedly dropped. The intention of our study was to demonstrate the persisting diagnostic and therapeutic impact of LAG on the postoperative patient with known or suspected lymphatic vessel leakage. Between May 1, 1999, and April 30, 2006, we investigated pedal lipiodol-LAGs (18 monopedal, 2 bipedal) on 22 patients (16 male, 6 female) with known or suspected postoperative chylothorax, chylaskos, lymphocele, or lymphatic fistula. Ages varied from 26 to 81 years. The spectrum of operative procedures was broad: 6 thoracic, 5 abdominal, and 11 peripheral operations were performed. In 20 patients who underwent mono- or bipedal LAG for lymphatic vessel injury, we were able to demonstrate the specific site of leakage in 15 cases (75%) and found signs of extravasation in 5 patients (25%). Furthermore, in 11 patients (55%) we were able to avoid surgery because of closure of the leak after LAG. As the conservative therapeutic approach usually takes 2-3 weeks to reveal its therapeutic effects, 73.3% (11/15) of the patients who were not reoperated before this hallmark was passed did not need any further operation. Our study clearly demonstrates that even in the decades of modern cross-sectional imaging, classic LAG is a powerful and highly reliable tool to visualize and even assist occlusion of the postoperatively damaged lymphatic vessel and may thereby avoid the need for reoperation.
自计算机断层扫描问世以来，淋巴管造影（LAG）的从业者数量和专业技能显著下降。我们研究的目的是证明LAG对已知或疑似淋巴管渗漏的术后患者持续具有诊断和治疗作用。在1999年5月1日至2006年4月30日期间，我们对22例已知或疑似术后乳糜胸、乳糜腹水、淋巴囊肿或淋巴瘘的患者（16例男性，6例女性）进行了足背碘油-LAG检查（18例单足，2例双足）。年龄从26岁到81岁不等。手术范围广泛：进行了6例胸部手术、5例腹部手术和11例外周手术。在20例因淋巴管损伤接受单足或双足LAG检查的患者中，我们在15例（75%）中明确了渗漏的具体部位，在5例（25%）中发现了外渗迹象。此外，在11例患者（55%）中，由于LAG后渗漏闭合，我们得以避免手术。由于保守治疗方法通常需要2至3周才能显示出治疗效果，在达到这一标志性时间之前未再次手术的患者中，73.3%（11/15）无需进一步手术。我们的研究清楚地表明，即使在现代横断面成像的几十年里，经典的LAG仍是一种强大且高度可靠的工具，可用于可视化甚至辅助闭塞术后受损的淋巴管，从而可能避免再次手术的需要。
