Kanai Veterinary Surgery, Himeji, Japan.
Study Group of Small Animal Minimally Invasive Treatment (SAMIT).
Vet Radiol Ultrasound. 2021 Jul;62(4):429-436. doi: 10.1111/vru.12966. Epub 2021 Mar 8.
Surgical treatment has improved the prognosis of canine idiopathic chylothorax, although a recurrence of the disease occurs occasionally after the procedure. An improved understanding of possible causes for this recurrence would be helpful for prognosis and treatment planning in affected patients. In this retrospective case series study, we described the detailed pre- and postoperative computed tomographic lymphography (CTLG) imaging characteristics for a group of dogs with surgically confirmed idiopathic chylothorax. Preoperative CTLG was performed in 12 of 14 dogs diagnosed with idiopathic chylothorax. Thoracic ducts were present on the right side in 10 dogs, left side in one dog, and bilaterally in one dog. All the 14 dogs received a combination therapy of pericardiectomy and thoracic duct ligation (TDL) by video-assisted thoracoscopic surgery. One week after surgery, a postoperative CTLG was performed, and the thoracic ducts were apparent in seven of 14 dogs. Three dogs had an unchanged course of the thoracic duct, which could have resulted from a missed duct. Four dogs were identified as having a bypass formation: the oblique duct originated at the ligation site and connected to the duct on the other side. Our findings indicated that one of the possible causes for postoperative recurrence of chylothorax in dogs could be "invisible or sleeping" fine ducts that are collapsed and not visible in preoperative CTLG scans. After TDL causes a change in the pressure of lymphatic flow, these fine thoracic ducts may become apparent using postoperative CTLG.
手术治疗改善了犬特发性乳糜胸的预后，但该疾病在手术后偶尔会复发。如果能更好地了解这种复发的可能原因，将有助于对受影响的患犬进行预后和治疗计划。在本回顾性病例系列研究中，我们描述了一组经手术证实的特发性乳糜胸犬的详细术前和术后计算机断层淋巴管造影（CTLG）成像特征。在 14 只被诊断为特发性乳糜胸的犬中，有 12 只进行了术前 CTLG。10 只犬的胸导管位于右侧，1 只位于左侧，1 只位于双侧。所有 14 只犬均通过胸腔镜辅助手术接受了心包切除术和胸导管结扎（TDL）的联合治疗。手术后 1 周进行了术后 CTLG，14 只犬中有 7 只可见胸导管。3 只犬的胸导管保持不变，这可能是由于导管未被结扎。4 只犬被确定为存在旁路形成：斜导管起源于结扎部位并与另一侧的导管相连。我们的研究结果表明，犬特发性乳糜胸术后复发的一个可能原因是“看不见或休眠”的细小导管，这些细小导管在术前 CTLG 扫描中塌陷而不可见。TDL 导致淋巴流动压力改变后，这些细小的胸导管可能会在术后 CTLG 中变得明显。
