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针对各种类型淋巴漏的淋巴介入治疗:入路与治疗

Lymphatic Intervention for Various Types of Lymphorrhea: Access and Treatment.

作者信息

Inoue Masanori, Nakatsuka Seishi, Yashiro Hideki, Tamura Masashi, Suyama Yohsuke, Tsukada Jitsuro, Ito Nobutake, Oguro Sota, Jinzaki Masahiro

机构信息

From the Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

出版信息

Radiographics. 2016 Nov-Dec;36(7):2199-2211. doi: 10.1148/rg.2016160053.

Abstract

Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization-comprising access to the TD followed by embolization-has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography-guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea. RSNA, 2016.

摘要

创伤性淋巴漏是一种罕见但可能危及生命的并发症。术后淋巴漏是创伤性淋巴漏的主要原因,可发生于淋巴系统的任何部位。分别通过淋巴结内淋巴管造影和经肝淋巴管造影可识别从主动脉髂区至胸导管(TD)以及肝淋巴管的漏口。因此,合适的淋巴管造影技术对于确定漏口来源至关重要。由于TD负责运输来自胃肠道、肝脏和主动脉髂区的大量淋巴液,因此TD损伤导致的乳糜胸可能很严重。经皮TD栓塞术(包括进入TD后进行栓塞)最近已成为高输出量乳糜胸手术TD结扎的一种微创替代方法。进入TD的途径选择取决于其解剖结构。如果无法通过此类方法进入TD,其他选择包括TD穿刺阻断或在漏口附近引流淋巴液后进行硬化治疗。大多数腹部淋巴漏病例源于主动脉 - 髂淋巴系统,单独进行淋巴管造影或计算机断层扫描引导下的硬化治疗可能会有帮助。罕见情况下,由于胃十二指肠韧带受损,肝淋巴管可能出现漏液,可通过经肝方式进行可视化和栓塞。本文全面综述了与临床相关的TD解剖变异、淋巴管造影技术及其选择标准以及淋巴漏的治疗策略。RSNA,2016年。

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