Hur Saebeom, Jun Hoyong, Jeong Yoon Soo
Department of Radiology, Seoul National University Hospital, Seoul, Korea.
Gland Surg. 2021 Mar;10(3):1260-1267. doi: 10.21037/gs-2019-ursoc-10.
Post-operative lymphatic leakage is a common complication of a radical gynecologic surgery involving aggressive lymph node dissection. Its manifestation varies from asymptomatic lymphoceles to life-threatening chylous ascites. In the past, nuclear medicine lymphoscintigraphy was the sole imaging modality for the confirmation of the leakage, of which application is limited due to its poor spatial resolution. While a conservative treatment with percutaneous drainage was the mainstream treatment method, surgical exploration was the last resort for the recalcitrant leakages. Recently, there have been a series of innovations in the field of interventional radiology, including intranodal Lipiodol lymphangiography, dynamic magnetic resonance (MR) lymphangiography, lymphatic embolization, and mesenteric lymph node lymphangiography. Intranodal Lipiodol lymphangiography provides very reliable and secure access to the lymphatic system, while requiring only fundamental skills and equipment available to all interventional radiologists. Besides, Lipiodol is being received a spotlight for its potential therapeutic effects on refractory lymphatic leakage. Dynamic MR lymphangiography plays a vital role in the diagnosis and management of non-traumatic lymphatic diseases, as well as in the post-operative lymphatic leakage with its superior contrast, spatial and temporal resolution. Lymphatic embolization is a technique of using N-BCA glue, a liquid embolic agent, for lymphatic leakages. It can be further described as lymphopseudoaneurysm (LPA) embolization or lymph node embolization, according to which structure is being embolized. Lymphatic embolization opened a new realm of possibilities in the field of interventional lymphology, resulting in the development of treatment approaches for chylous ascites and lymphoceles. Mesenteric lymph node lymphangiography offers the opacification of the upstream mesenteric chylous lymphatic system and can detect lymphatic leakage from the intestinal trunk or the more proximal parts of the mesenteric lymphatic system. With the advent of these latest interventional radiological techniques, more comprehensive approaches to the management of recalcitrant post-operative lymphatic leakages have been enabled.
术后淋巴漏是妇科根治性手术（包括广泛淋巴结清扫术）常见的并发症。其表现从无症状的淋巴管囊肿到危及生命的乳糜腹水不等。过去，核医学淋巴闪烁造影是确诊淋巴漏的唯一影像学检查方法，但由于其空间分辨率较差，应用受限。虽然经皮引流的保守治疗是主流治疗方法，但手术探查是治疗顽固性淋巴漏的最后手段。近年来，介入放射学领域出现了一系列创新技术，包括节点内碘油淋巴管造影、动态磁共振（MR）淋巴管造影、淋巴栓塞和肠系膜淋巴结淋巴管造影。节点内碘油淋巴管造影为进入淋巴系统提供了非常可靠和安全的途径，且只需要所有介入放射科医生都具备的基本技术和设备。此外，碘油因其对难治性淋巴漏的潜在治疗作用而受到关注。动态MR淋巴管造影凭借其出色的对比度、空间和时间分辨率，在非创伤性淋巴疾病的诊断和管理以及术后淋巴漏方面发挥着重要作用。淋巴栓塞是一种使用液体栓塞剂N-氰基丙烯酸正丁酯（N-BCA胶）治疗淋巴漏 的技术。根据栓塞的结构不同，它可进一步分为淋巴假性动脉瘤（LPA）栓塞或淋巴结栓塞。淋巴栓塞为介入淋巴学领域开辟了新的可能性，推动了乳糜腹水和淋巴管囊肿治疗方法的发展。肠系膜淋巴结淋巴管造影可使肠系膜上游乳糜淋巴系统显影，并能检测来自肠干或肠系膜淋巴系统更近端部位的淋巴漏。随着这些最新介入放射学技术的出现，对于顽固性术后淋巴漏的处理有了更全面的方法。
