非手术性胸导管栓塞治疗创伤性胸导管漏：109 例经验。
Nonoperative thoracic duct embolization for traumatic thoracic duct leak: experience in 109 patients.
机构信息
Hospital of the University of Pennsylvania, Interventional Radiology, 3400 Spruce St, Philadelphia, PA 19004, USA.
出版信息
J Thorac Cardiovasc Surg. 2010 Mar;139(3):584-89; discussion 589-90. doi: 10.1016/j.jtcvs.2009.11.025. Epub 2009 Dec 29.
OBJECTIVE
To demonstrate the efficacy of a minimally invasive, nonoperative, catheter-based approach to the treatment of traumatic chyle leak.
METHODS
A retrospective review of 109 patients was conducted to assess the efficacy of thoracic duct embolization or interruption for the treatment of high-output chyle leak caused by injury to the thoracic duct.
RESULTS
A total of 106 patients presented with chylothorax, 1 patient presented with chylopericardium, and 2 patients presented with cervical lymphocele. Twenty patients (18%) had previous failed thoracic duct ligation. In 108 of 109 patients, a lymphangiogram was successful. Catheterization of the thoracic duct was achieved in 73 patients (67%). In 71 of these 73 patients, embolization of the thoracic duct was performed. Endovascular coils or liquid embolic agent was used to occlude the thoracic duct. In 18 of 33 cases of unsuccessful catheterization, thoracic duct needle interruption was attempted below the diaphragm. Resolution of the chyle leak was observed in 64 of 71 patients (90%) post-embolization. Needle interruption of the thoracic duct was successful in 13 of 18 patients (72%). In 17 of the 20 patients who had previous attempts at thoracic duct ligation, embolization or interruption was attempted and successful in 15 (88%). The overall success rate for the entire series was 71% (77/109). There were 3 (3%) minor complications.
CONCLUSION
Catheter embolization or needle interruption of the thoracic duct is safe, feasible, and successful in eliminating a high-output chyle leak in the majority (71%) of patients. This minimally invasive, although technically challenging, procedure should be the initial approach for the treatment of a traumatic chylothorax.
目的
展示一种微创、非手术、基于导管的方法治疗创伤性乳糜漏的疗效。
方法
回顾性分析了 109 例患者，评估了胸导管栓塞或中断治疗胸导管损伤引起的高输出乳糜漏的疗效。
结果
共有 106 例患者出现乳糜胸，1 例患者出现乳糜心包积液，2 例患者出现颈淋巴囊肿。20 例（18%）患者有既往胸导管结扎失败史。在 109 例患者中，108 例淋巴管造影成功。73 例（67%）患者成功进行了胸导管置管。在这 73 例患者中，71 例行胸导管栓塞。血管内线圈或液体栓塞剂用于闭塞胸导管。在 33 例置管不成功的病例中，尝试在膈肌下方进行胸导管针中断。栓塞后，71 例患者中有 64 例（90%）乳糜漏得到缓解。在 18 例胸导管针中断成功的患者中，13 例（72%）患者成功。在 20 例既往有胸导管结扎尝试的患者中，有 15 例（88%）尝试并成功进行了栓塞或中断。整个系列的总体成功率为 71%（77/109）。有 3 例（3%）轻微并发症。
结论
导管栓塞或胸导管针中断是安全、可行的，可成功消除大多数（71%）患者的高输出乳糜漏。这种微创方法虽然技术上具有挑战性，但应作为创伤性乳糜胸的初始治疗方法。
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