Alejandre-Lafont Enrique, Krompiec Christoph, Rau Wigbert S, Krombach Gabriele A
Department of Radiology, Justus Liebig University Giessen, Germany.
Acta Radiol. 2011 Apr 1;52(3):305-11. doi: 10.1258/ar.2010.090356.
The number of conventional lymphographies has declined markedly since the introduction of cross-sectional imaging techniques. Nevertheless, lymphography has a high potential as a reliable method to visualize and directly occlude lymphatic leaks. When used as a distinct radiological procedure with the intention to treat, this application can be described as therapeutic lymphography.
To investigate if therapeutic lymphography is a reliable method to treat lymphatic leakage when conservative treatment fails and to investigate which parameters influence the success rate.
Between August 1995 and January 2008, 50 patients with lymphatic leakage in form of chylothorax, chylous ascites, lymphocele, and lymphatic fistulas underwent conventional therapeutic lymphography after failure of conservative therapy. Of these 50 patients, seven could not be statistically evaluated in our retrospective study: one patient died of cancer 1 day after lymphography, and six were excluded due to various technical problems. The remaining 43 patients were evaluated. Therapeutic success was evaluated and correlated to the volume of lymphatic leakage (more or less than 500 mL/day), as assessed by drainage.
In nearly 79% of patients, the location of the leak could be detected, and surgical intervention could be planned when therapeutic lymphography failed. Due to the irrigating effect of the contrast medium (lipiodol), the lymphatic leak could be completely occluded in 70% of patients when the lymphatic drainage volume was less than 500 mL/day. Even when lymphatic drainage was higher than 500 mL/day, therapeutic lymphography was still successful in 35% of the patients. The overall success rate in patients with failed conservative treatment was 51%. Success did not depend on other factors such as age and sex, cause of lymph duct damage, or time elapsed between lymphatic injury and intervention.
Therapeutic lymphography is an effective method in the treatment of lymphatic leakage when conservative therapy fails. The volume of lymphatic drainage per day is a significant predictor of the therapeutical success rate.
自横断面成像技术引入以来，传统淋巴造影的数量显著下降。然而，淋巴造影作为一种可视化和直接封堵淋巴漏的可靠方法具有很高的潜力。当作为一种有治疗意图的独特放射学程序使用时，这种应用可被描述为治疗性淋巴造影。
研究当保守治疗失败时，治疗性淋巴造影是否是治疗淋巴漏的可靠方法，并研究哪些参数会影响成功率。
1995年8月至2008年1月期间，50例以乳糜胸、乳糜腹水、淋巴囊肿和淋巴瘘形式出现淋巴漏的患者在保守治疗失败后接受了传统治疗性淋巴造影。在这50例患者中，7例在我们的回顾性研究中无法进行统计学评估：1例患者在淋巴造影后1天死于癌症，6例因各种技术问题被排除。对其余43例患者进行了评估。评估治疗成功率，并将其与通过引流评估的淋巴漏量（每天多于或少于500 mL）相关联。
在近79%的患者中，可以检测到漏口的位置，当治疗性淋巴造影失败时可以计划手术干预。由于造影剂（碘油）的冲洗作用，当淋巴引流量小于500 mL/天时，70%的患者淋巴漏可被完全封堵。即使淋巴引流量高于500 mL/天，治疗性淋巴造影在35%的患者中仍取得成功。保守治疗失败患者的总体成功率为51%。成功与否不取决于其他因素，如年龄、性别、淋巴管损伤原因或淋巴损伤与干预之间的时间间隔。
当保守治疗失败时，治疗性淋巴造影是治疗淋巴漏的有效方法。每天的淋巴引流量是治疗成功率的重要预测指标。
