Kaschner G M, Strunk H
Radiologische Klinik, Universitätsklinikum Bonn.
Dtsch Med Wochenschr. 2014 Oct;139(44):2231-6. doi: 10.1055/s-0034-1387288. Epub 2014 Oct 21.
To evaluate the feasibility of ultrasound-guided transnodal lymphangiography as an modified technique for visualization of the abdomino-thoracic lymphatic system for thoracic duct embolization in patients with chylothorax after thoracic surgery.
10 patients (six men and four women, mean age 53 y [range, 22-72 y]) with chylothorax after thoracic surgery underwent ultrasound-guided transnodal lymphangiography. An inguinal lymph node was accessed under ultrasound guidance with a 25-gauge spinal needle and lipiodol was injected. Opacification of the lymphatic system was intermittently controlled by fluoroscopy. The thoracic duct was percutaneously accessed and embolization was performed. Following mean times were assessed: for the procedure of inguinal puncture, number of inguinal punctures, time from start of lipiodol injection until inguinal lymphangiogram, volume of injected contrast media, duration of opacification of target lymphatics, number of percutaneous punctions and time for thoracic duct access, time for thoracic duct embolization and complications. Procedure times until initial lymphangiogram were compared with times of a control group (n=10) in patients who had undergone pedal lymphangiography.
The procedure of ultrasound guided lymph node puncture was successful in all cases (10 /10). Mean procedure times from inguinal access to initial lymphangiogram were 12.3 ± 2 minutes (pedal lymphangiography : 30.4 ± 5 minutes). Average of inguinal punctions was 1.3 (1-3). Small extravasation occurred in 4 of 10 patients. In 2 patients a contralateral inguinal punction was necessary because of lymphovenous shunts. In 10 /10 patients the lymphatic systems was opacified about 24.5 ± 9 minutes for thoracic duct embolization without required additional injection. Average of thoracic duct punctions were 1.5 (1-3). Procedure times until catheterization of the target lymphatics and until embolization of the thoracic duct were 19.3 ± 9 minutes and 14.5 ± 2 minutes respectively.
Ultrasound-guided transnodal lymphangiography is a less technically challenging technique for opacification of the abdomino-thoracal lymphatic system for subsequent thoracic duct embolization.
评估超声引导下经淋巴结淋巴管造影作为一种改良技术用于可视化胸腹部淋巴系统，以对胸外科手术后乳糜胸患者进行胸导管栓塞的可行性。
10例胸外科手术后发生乳糜胸的患者（6例男性，4例女性，平均年龄53岁[范围22 - 72岁]）接受了超声引导下经淋巴结淋巴管造影。在超声引导下用25号脊椎穿刺针穿刺腹股沟淋巴结并注入碘油。通过荧光透视间歇性控制淋巴系统的显影。经皮穿刺胸导管并进行栓塞。评估以下平均时间：腹股沟穿刺操作时间、腹股沟穿刺次数、从开始注入碘油到腹股沟淋巴管造影的时间、注入造影剂的体积、目标淋巴管显影持续时间、经皮穿刺次数和胸导管穿刺时间、胸导管栓塞时间及并发症。将直至首次淋巴管造影的操作时间与接受足背淋巴管造影的对照组患者（n = 10）的时间进行比较。
所有病例（10/10）超声引导下淋巴结穿刺操作均成功。从腹股沟穿刺到首次淋巴管造影的平均操作时间为12.3 ± 2分钟（足背淋巴管造影：30.4 ± 5分钟）。腹股沟穿刺平均次数为1.3次（1 - 3次）。10例患者中有4例出现少量造影剂外渗。2例患者因淋巴静脉分流需要对侧腹股沟穿刺。10/10例患者在无需额外注射的情况下，胸导管栓塞的淋巴系统显影约24.5 ± 9分钟。胸导管穿刺平均次数为1.5次（1 - 3次）。直至目标淋巴管插管和直至胸导管栓塞的操作时间分别为19.3 ± 9分钟和14.5 ± 2分钟。
超声引导下经淋巴结淋巴管造影是一种技术难度较低的技术，用于使胸腹部淋巴系统显影以便后续进行胸导管栓塞。
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