食管癌切除术后胸导管异常所致乳糜胸的淋巴管造影及局部胸膜固定术治疗：一例报告
Lymphangiography and focal pleurodesis treatment of chylothorax with an aberrant thoracic duct following oesophagectomy: a case report.
作者信息
Ishida Tomoyuki, Kanamori Jun, Daiko Hiroyuki
机构信息
Department of Esophageal Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
出版信息
Surg Case Rep. 2019 Dec 11;5(1):195. doi: 10.1186/s40792-019-0709-3.
BACKGROUND
Management of postoperative chylothorax usually consists of nutritional regimens, pharmacological therapies such as octreotide, and surgical therapies such as ligation of thoracic duct, but a clear consensus is yet to be reached. Further, the variation of the thoracic duct makes chylothorax difficult to treat. This report describes a rare case of chylothorax with an aberrant thoracic duct that was successfully treated using focal pleurodesis through interventional radiology (IVR).
CASE PRESENTATION
The patient was a 52-year-old man with chylothorax after a thoracoscopic oesophagectomy for oesophageal cancer. With conventional therapy, such as thoracostomy tube, octreotide or fibrogammin, a decrease in the amount of chyle was not achieved. Therefore, we performed lymphangiography and pleurodesis through IVR. The patient appeared to have an aberrant thoracic duct, as revealed by magnetic resonance imaging (MRI); however, after focal pleurodesis, the leak of chyle was diminished, and the patient was discharged 66 days after admission.
CONCLUSIONS
Chylothorax remains a difficult complication. Focal pleurodesis through IVR can be one of the options to treat chylothorax.
背景
术后乳糜胸的治疗通常包括营养方案、诸如奥曲肽的药物治疗以及诸如胸导管结扎术的手术治疗，但尚未达成明确的共识。此外，胸导管的变异使得乳糜胸难以治疗。本报告描述了一例罕见的乳糜胸病例，其胸导管异常，通过介入放射学（IVR）进行局部胸膜固定术成功治疗。
病例介绍
该患者为一名52岁男性，因食管癌接受胸腔镜食管切除术后发生乳糜胸。采用常规治疗方法，如胸腔闭式引流管、奥曲肽或纤维蛋白原，乳糜量并未减少。因此，我们通过IVR进行了淋巴管造影和胸膜固定术。磁共振成像（MRI）显示患者似乎有一条异常的胸导管；然而，经过局部胸膜固定术后，乳糜渗漏减少，患者入院66天后出院。
结论
乳糜胸仍然是一种难治的并发症。通过IVR进行局部胸膜固定术可以作为治疗乳糜胸的选择之一。
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