Wang Hsiang-Wei, Escott Alistair Brian James, Phang Kian Luke, Petrov Maxim S, Phillips Anthony Ronald John, Windsor John Albert
Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand; Applied Surgery and Metabolism Laboratory, School of Biological Science, Faculty of Science, University of Auckland, Auckland, New Zealand.
Department of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
J Surg Res. 2016 Jul;204(1):213-27. doi: 10.1016/j.jss.2016.04.050. Epub 2016 Apr 27.
The evolution of the "gut-lymph concept" has promoted thoracic duct (TD) lymph drainage as a possible treatment to reduce systemic inflammation and end-organ dysfunction in acute illness. The aim was to review the published experience of thoracic duct interventions (TDIs) aimed at improving clinical outcomes.
A search of three databases (MEDLINE, EMBASE, and EMBASE CLASSIC) over the last 60 y. The indications for intervention, the technique, and clinical outcomes were reviewed.
There were a wide range of indications for TDI. These included reducing rejection after transplantation, treating inflammatory diseases, and reducing chronic failure of the liver, kidney, and heart. The techniques included TD cannulation and lymphovenuous fistula. The outcomes were variable and often equivocal, and this appears to reflect poor design quality. There is clinical equipoise regarding a therapeutic role of (TD lymph drainage in acute pancreatitis, and probably other acute diseases.
Until well-designed clinical trials are undertaken, the clinical benefits of TDIs will remain promising, but uncertain.
“肠 - 淋巴概念”的演变推动了胸导管（TD）淋巴引流作为一种可能的治疗方法，以减轻急性疾病中的全身炎症和终末器官功能障碍。目的是回顾已发表的旨在改善临床结局的胸导管干预（TDI）经验。
检索过去60年的三个数据库（MEDLINE、EMBASE和EMBASE CLASSIC）。对干预指征、技术和临床结局进行了回顾。
TDI有广泛的指征。这些包括减少移植后的排斥反应、治疗炎症性疾病以及减少肝、肾和心脏的慢性衰竭。技术包括TD插管和淋巴静脉瘘。结局各不相同且往往不明确，这似乎反映了设计质量较差。对于TD淋巴引流在急性胰腺炎以及可能其他急性疾病中的治疗作用存在临床平衡。
在进行精心设计的临床试验之前，TDI的临床益处将仍然有前景，但不确定。
