Lambertz Rolf, Chang De-Hua, Hickethier Tilman, Bagheri Mahsa, Leers Jessica M, Bruns Christiane J, Schröder Wolfgang
Department of General, Visceral and Cancer Surgery, University of Cologne, Cologne, Germany.
Department of Radiology, University of Cologne, Cologne, Germany.
Innov Surg Sci. 2019 Mar 9;4(3):85-90. doi: 10.1515/iss-2018-0037. eCollection 2019 Sep.
Postoperative chylothorax is a serious complication after transthoracic esophagectomy, and is associated with major morbidity due to dehydration and malnutrition. For patients with high-output fistula, re-thoracotomy with ligation of the thoracic duct is the treatment of choice. Radiologic interventional management is an innovative procedure that has the potential to replace surgery in the treatment algorithm.
Four patients with high-output chylous leaks following esophagectomy are presented. Ultrasound-guided lymphangiography with embolization of the thoracic duct and/or disruption of the cisterna chyli was performed to occlude the leakage site. Radiologic interventions and procedure-related outcomes are described in detail.
In all four patients, ultrasound-guided lymphangiography of the groin with injection of Lipiodol was able to detect and visualize the leakage site in the lower mediastinum. In three patients, the leak could be successfully occluded by Lipiodol embolization. In one patient, embolization failed and the disruption technique was successfully performed. No procedure-related complications were observed.
In case of a postoperative chylothorax, radiologic intervention is feasible and safe. The procedure is indicated for high-output chylous fistulas after esophagectomy, and should be applied early after the diagnosis of this postoperative complication.
术后乳糜胸是经胸段食管癌切除术后的一种严重并发症，与因脱水和营养不良导致的严重发病相关。对于高流量瘘患者，开胸结扎胸导管是首选治疗方法。放射介入治疗是一种创新方法，有可能在治疗方案中替代手术。
介绍了4例食管癌切除术后出现高流量乳糜漏的患者。采用超声引导下淋巴管造影并栓塞胸导管和/或破坏乳糜池以封闭漏出部位。详细描述了放射介入治疗及与手术相关的结果。
在所有4例患者中，超声引导下经腹股沟注射碘油进行淋巴管造影能够检测并显示下纵隔的漏出部位。3例患者中，碘油栓塞成功封闭了漏口。1例患者栓塞失败，采用破坏技术成功治疗。未观察到与手术相关的并发症。
对于术后乳糜胸病例，放射介入治疗可行且安全。该方法适用于食管癌切除术后的高流量乳糜瘘，应在诊断出这种术后并发症后尽早应用。
