Kim Pyeong Hwa, Tsauo Jiaywei, Shin Ji Hoon
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Republic of Korea.
Department of Interventional Therapy, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Vasc Interv Radiol. 2018 Feb;29(2):194-202.e4. doi: 10.1016/j.jvir.2017.10.006. Epub 2017 Dec 27.
To perform a systematic review and meta-analysis of published studies to evaluate the efficacy of lymphatic interventions for chylothorax.
The MEDLINE, EMBASE, and Cochrane databases were searched for English-language studies until March 2017 that included patients with chylothorax treated with lymphangiography (LAG), thoracic duct embolization (TDE), or thoracic duct disruption (TDD). Exclusion criteria were as follows: a sample size of less than 10 patients, no extractable data, or data included in subsequent articles or duplicate reports.
The cases of 407 patients from 9 studies were evaluated. The pooled technical success rates of LAG and TDE were 94.2% (95% confidence interval [CI], 88.4%-97.2%; I = 46.7%) and 63.1% (95% CI, 55.4%-70.2%; I = 37.3%), respectively. The pooled clinical success rates of LAG, TDE, and TDD, on a per-protocol basis, were 56.6% (95% CI, 45.4%-67.2%; I = 5.4%), 79.4% (95% CI, 64.8%-89.0%; I = 68.1%), and 60.8% (95% CI, 49.4%-71.2%; I = 0%), respectively. The pooled major complication rate of LAG and TDE was 1.9% (95% CI, 0.8%-4.3%; I = 0%) and 2.4% (95% CI, 0.9%-6.6%; I = 26.4%), respectively. The pooled overall clinical success rate of lymphatic interventions, on an intention-to-treat basis, was 60.1% (95% CI, 52.1%-67.7%; I = 54.3%). Etiology of chylothorax was identified as a significant source of heterogeneity for the pooled clinical success rate of TDE and overall clinical success rate.
Lymphatic interventions have a respectable efficacy for the treatment of chylothorax.
对已发表的研究进行系统评价和荟萃分析，以评估淋巴介入治疗乳糜胸的疗效。
检索MEDLINE、EMBASE和Cochrane数据库，查找截至2017年3月的英文研究，这些研究纳入了接受淋巴管造影（LAG）、胸导管栓塞术（TDE）或胸导管破坏术（TDD）治疗的乳糜胸患者。排除标准如下：样本量少于10例患者、无可提取数据，或数据包含在后续文章或重复报告中。
对9项研究中的407例患者病例进行了评估。LAG和TDE的合并技术成功率分别为94.2%（95%置信区间[CI]，88.4%-97.2%；I²=46.7%）和63.1%（95%CI，55.4%-70.2%；I²=37.3%）。按方案分析，LAG、TDE和TDD的合并临床成功率分别为56.6%（95%CI，45.4%-67.2%；I²=5.4%）、79.4%（95%CI，64.8%-89.0%；I²=68.1%）和60.8%（95%CI，49.4%-71.2%；I²=0%）。LAG和TDE的合并主要并发症发生率分别为1.9%（95%CI，0.8%-4.3%；I²=0%）和2.4%（95%CI，0.9%-6.6%；I²=26.4%）。基于意向性分析，淋巴介入治疗的合并总体临床成功率为60.1%（95%CI，52.1%-67.7%；I²=54.3%）。乳糜胸的病因被确定为TDE合并临床成功率和总体临床成功率异质性的重要来源。
淋巴介入治疗乳糜胸具有可观的疗效。
