Atie M, Dunn G, Falk G L
Department of Upper GI Surgery, Concord Repatriation General Hospital, Hospital Road, Sydney, NSW 2139, Australia.
Department of Radiology, Concord Repatriation General Hospital, Hospital Road, Sydney, NSW 2139, Australia.
Int J Surg Case Rep. 2016;23:12-6. doi: 10.1016/j.ijscr.2016.04.002. Epub 2016 Apr 7.
Chyle leak after oesophagectomy is highly morbid and may carry significant mortality if treatment is delayed. Identification of the site of leakage and surgery may be plagued by failure.
We describe a case of chyle leak after oesophagectomy. Lymphangiography revealed the site of chyle leak to be an aberrant duct that would have been difficult to identify surgically. Radiological coiling and embolization successfully treated the leak.
The gold standard for treatment of chyle leak or chylothorax after oesophagectomy was a re-operation, either open or throracoscopic, to ligate the thoracic duct. The interventional radiological technique employed in our case was not only efficacious in stopping the leak, but had the added advantage of identifying the site and highlighting the anatomy hence avoiding a morbid reoperation. The literature is reviewed.
The report and review confirm that lymphangiography followed by coiling and embolization for chylothorax post oesophagectomy is safe and effective in a majority of cases.
食管切除术后乳糜漏的病情严重，如果治疗延迟可能导致显著的死亡率。漏出部位的识别和手术可能会因失败而受阻。
我们描述了一例食管切除术后乳糜漏的病例。淋巴管造影显示乳糜漏的部位是一条异常导管，手术中很难识别。放射学线圈栓塞术成功治愈了漏出。
食管切除术后乳糜漏或乳糜胸的治疗金标准是再次手术，无论是开放手术还是胸腔镜手术，以结扎胸导管。我们病例中采用的介入放射学技术不仅有效地止住了漏出，还具有识别部位和突出解剖结构的额外优势，从而避免了一次高风险的再次手术。对相关文献进行了综述。
该报告和综述证实，食管切除术后乳糜胸采用淋巴管造影后进行线圈栓塞术在大多数情况下是安全有效的。
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