Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
Department of Urology, Seoul National University College of Medicine, Seoul, Korea.
Korean J Radiol. 2021 Mar;22(3):376-383. doi: 10.3348/kjr.2020.0056. Epub 2020 Aug 28.
To assess the safety and efficacy of lymphopseudoaneurysm (LPA) glue (n-butyl cyanoacrylate [NBCA]) embolization in the management of chylous ascites after retroperitoneal surgery.
A retrospective analysis from January 2014 to October 2018 was performed in six patients (4 females and 2 males; mean age, 45.3 ± 14.2 years; range, 26-61 years) who underwent LPA embolization for chylous ascites developing after retroperitoneal surgery involving the perirenal space (four donor nephrectomies, one partial nephrectomy, and one retroperitoneal lymphadenectomy). After placing a percutaneous drainage catheter into the LPA or adjacent lymphocele, embolization was performed by filling the LPA itself with a mixture of glue and Lipiodol (Guerbet).
Daily drainage from percutaneously placed drains exceeded 300 mL/day despite medical and surgical treatment (volume: mean, 1173 ± 1098 mL; range, 305-2800 mL). Intranodal lymphangiography was performed in four of the six patients and revealed leakage in 2 patients. Percutaneous embolization of the LPA was successful in all patients using an NBCA and Lipiodol mixture in a ratio of 1:1-1:2 (volume: mean, 4.3 ± 1.1 mL; range, 3-6 mL). Chylous ascites was resolved and the drainage catheter was removed in all patients within 4 days after the procedure (mean, 2.0 ± 1.8 days; range, 0-4 days). No procedure-related complications or recurrence of chylous ascites occurred during a mean follow-up period of 37.3 months (range, 21.1-48.4 months).
Glue embolization of LPA has the potential to be a feasible and effective treatment method for the management of chylous ascites after retroperitoneal surgery.
评估淋巴假性动脉瘤（LPA）胶（正丁基氰基丙烯酸酯[NBCA]）栓塞治疗腹膜后手术后乳糜性腹水的安全性和疗效。
对 2014 年 1 月至 2018 年 10 月期间 6 例（4 女 2 男；平均年龄 45.3±14.2 岁；范围 26-61 岁）腹膜后手术涉及肾周间隙（4 例供肾切除术、1 例部分肾切除术和 1 例腹膜后淋巴结清扫术）后发生 LPA 乳糜性腹水的患者行 LPA 栓塞治疗的回顾性分析。在 LPA 或邻近淋巴管囊肿内放置经皮引流导管后，用混合胶和碘化油（Guerbet）充盈 LPA 本身进行栓塞。
尽管进行了内科和外科治疗，但经皮放置的引流管每天的引流量仍超过 300 mL/天（量：平均 1173±1098 mL；范围 305-2800 mL）。6 例患者中有 4 例行淋巴结内淋巴造影术，其中 2 例显示漏出。所有患者均成功地用 1∶1-1∶2（体积：平均 4.3±1.1 mL；范围 3-6 mL）的 NBCA 和碘化油混合物经皮栓塞 LPA。所有患者在手术后 4 天内（平均 2.0±1.8 天；范围 0-4 天）乳糜性腹水得到解决并拔除引流管。在平均 37.3 个月（范围 21.1-48.4 个月）的随访期间，无与操作相关的并发症或乳糜性腹水复发。
LPA 胶栓塞术有可能成为腹膜后手术后乳糜性腹水的一种可行且有效的治疗方法。
