Jiménez Gómez J, Gómez Cervantes M, Núñez Cerezo V, Amesty Morello V, Ponce Dorrego M D, Nava Hurtado de Saracho F B, Martínez Martínez L, López Gutiérrez J C
Departamento de Cirugía Pediátrica. Hospital Universitario La Paz. Madrid.
Unidad de Radiología Vascular e Intervencionista, Servicio de Radiodiagnóstico. Hospital Universitario La Paz. Madrid.
Cir Pediatr. 2019 Jan 21;32(1):41-45.
High morbidity has been described in secondary chylothorax. Thoracic duct embolization (TDE) after intranodal lymphangiography (IL) is one of the treatments in adults but there is poor experience in children. We aim to describe our experience with this technique for refractory pediatric chylothorax.
A retrospective study of patients with refractory chylothorax treated with thoracic duct embolization at our Institution in the last 4 years was performed. Lymphatic vessels visualization was obtained by intranodal lymphangiography with ethiodized oil. Demographic and clinical data as well as imaging findings were collected.
A total of 4 patients were treated during the study period with a median of age and weight of 2.5 months (1-16) and 4.25 kg (2.8-10) respectively. Chylothorax was secondary to cardiothoracic surgery in 3 patients and to venous thrombosis in the other one. Medical treatment was provided during a median of 47 days (13-56) without benefit in thoracic output [median: 46 ml/kg/day (19-64)]. After IL, thoracic duct catheterization was achieved in one patient however embolization was not possible. Chylothorax stopped in the 3 post-surgical patients regardless of how much lymphatic visualization was achieved in IL. In the venous thrombosis patient surgical treatment was performed 6 days after the study.
IL can be a diagnostic and therapeutic tool in children. Ethiodized oil seems to seal lymphatic leak in postsurgical chylothorax. IL could be an option for chylothorax in patients too sick for surgical treatment or in whom thoracic duct embolization is not feasible.
继发性乳糜胸的发病率较高。结内淋巴管造影（IL）后进行胸导管栓塞术（TDE）是成人的治疗方法之一，但儿童应用经验较少。我们旨在描述我们使用该技术治疗难治性小儿乳糜胸的经验。
对过去4年在我院接受胸导管栓塞术治疗的难治性乳糜胸患者进行回顾性研究。通过用乙碘油进行结内淋巴管造影来观察淋巴管。收集人口统计学和临床数据以及影像学检查结果。
在研究期间共治疗了4例患者，年龄中位数和体重中位数分别为2.5个月（1 - 16个月）和4.25千克（2.8 - 10千克）。3例患者的乳糜胸继发于心胸外科手术，另1例继发于静脉血栓形成。中位治疗时间为47天（13 - 56天），在此期间进行了药物治疗，但胸腔引流量无改善[中位数：46毫升/千克/天（19 - 64毫升/千克/天）]。IL后，1例患者成功进行了胸导管插管，但无法进行栓塞。3例手术后患者的乳糜胸停止，无论IL中淋巴管显影情况如何。静脉血栓形成患者在研究6天后进行了手术治疗。
IL在儿童中可以作为一种诊断和治疗工具。乙碘油似乎可以封闭手术后乳糜胸的淋巴漏。对于病情过重无法进行手术治疗或胸导管栓塞不可行的乳糜胸患者，IL可能是一种选择。
