Girotra Mohit, Horwhat John D, Settle Timothy L, Parasher Vinod K
Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University/Sinai Hospital Program in Internal Medicine, Baltimore, MD 21215, USA.
J Laparoendosc Adv Surg Tech A. 2013 Jul;23(7):588-91. doi: 10.1089/lap.2012.0451. Epub 2013 May 23.
The study of lymph as a biofluid is lacking because of absence of a safe site and technique for lymph acquisition. Injury to the thoracic duct during surgery is known to cause chylothorax. The aim of this interventional study was to puncture the thoracic duct under endoscopic ultrasound (EUS) guidance and observe for complications in a swine model.
Three female Yorkshire pigs underwent EUS. The thoracic duct was identified by the previously described technique, punctured, and confirmed with a lymphangiogram. Postoperatively, animals were fed and monitored closely for any complications or signs of abnormal behavior indicating pain and/or disease. The animals were euthanized at 1 week, and necropsy was performed per protocol. Main outcome measurements included complications (chylothorax, mediastinitis, perforation, and hemorrhage) during the post-EUS-guided thoracic duct puncture period.
No animals developed any complications during the survival period. The thoracic duct was identified and punctured in all animals. A lymphangiogram was additionally obtained to confirm ductal access. No chylothorax, mediastinitis, hematoma, abscess, or fistula formation was identified in any animal on necropsy.
EUS-guided transesophageal thoracic duct puncture is safe as demonstrated by this survival study.
由于缺乏获取淋巴液的安全部位和技术，对淋巴作为生物流体的研究较为匮乏。手术中胸导管损伤已知会导致乳糜胸。本介入性研究的目的是在内镜超声（EUS）引导下穿刺胸导管，并在猪模型中观察并发症情况。
三只雌性约克夏猪接受了EUS检查。通过先前描述的技术识别胸导管，进行穿刺，并通过淋巴管造影进行确认。术后，给动物喂食并密切监测是否有任何并发症或异常行为迹象，以表明疼痛和/或疾病。在1周时对动物实施安乐死，并按方案进行尸检。主要观察指标包括EUS引导下胸导管穿刺术后期间的并发症（乳糜胸、纵隔炎、穿孔和出血）。
在存活期内，没有动物出现任何并发症。所有动物均成功识别并穿刺了胸导管。另外进行了淋巴管造影以确认导管通路。尸检时在任何动物中均未发现乳糜胸、纵隔炎、血肿、脓肿或瘘管形成。
这项存活研究表明，EUS引导下经食管胸导管穿刺是安全的。
