Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, California.
Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California.
Microsurgery. 2019 Mar;39(3):255-258. doi: 10.1002/micr.30339. Epub 2018 Jul 4.
Thoracic duct injury can be a devastating injury with disruption of lymphatic flow leading to potentially chylothorax and/or severe lymphedema. Standard treatment modalities include thoracic duct ligation or embolization for chylothorax, but treatment options to date are few for resultant lymphedema. In this case report, we describe lymphaticovenous bypass of the thoracic duct to the jugular venous system in a 21-year-old male with secondary lymphedema after iatrogenic thoracic duct injury. The patient experienced improvement of lymphedema symptoms including decreased weight and limb girth as well as normalization of serum markers indicating improved lymphatic delivery to the venous system. Lymphangiogram at 3 months post op demonstrated patency of the lymphaticovenous anastomoses. At 6-month follow-up, the patient had returned to his preoperative level of activity and showed continued improvement of his lymphedema symptoms. Lymphovenous bypass of the thoracic duct may be an effective technique to treat secondary lymphedema from thoracic duct obstruction, though further studies are required to determine long-term efficacy.
胸导管损伤可能是一种毁灭性的损伤，会破坏淋巴液流动，导致乳糜胸和/或严重的淋巴水肿。标准的治疗方法包括胸导管结扎或栓塞治疗乳糜胸，但迄今为止，对于由此导致的淋巴水肿，治疗选择很少。在本病例报告中，我们描述了 1 例 21 岁男性患者在医源性胸导管损伤后发生继发性淋巴水肿时，采用胸导管至颈静脉系统的淋巴管静脉旁路手术。该患者的淋巴水肿症状得到改善，包括体重和肢体周长减小，以及血清标志物正常化，表明淋巴液向静脉系统的输送得到改善。术后 3 个月的淋巴造影显示淋巴管静脉吻合通畅。6 个月随访时，患者已恢复术前活动水平，淋巴水肿症状持续改善。胸导管淋巴管静脉旁路术可能是治疗胸导管阻塞引起的继发性淋巴水肿的有效方法，但需要进一步研究以确定长期疗效。
