Clinic of Diagnostic and Interventional Radiology, Stuttgart Clinics, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
Clinic of Diagnostic and Interventional Radiology, Heidelberg University Hospital, INF 420, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2021 Jun;406(4):945-969. doi: 10.1007/s00423-021-02094-z. Epub 2021 Apr 12.
Postoperative lymphorrhea can occur after different surgical procedures and may prolong the hospital stay due to the need for specific treatment. In this work, the therapeutic significance of the radiological management of postoperative lymphorrhea was assessed and illustrated.
A standardized search of the literature was performed in PubMed applying the Medical Subject Headings (MeSH) term "lymphangiography." For the review, the inclusion criterion was "studies with original data on Lipiodol-based Conventional Lymphangiography (CL) with subsequent Percutaneous Lymphatic Intervention (PLI)." Different exclusion criteria were defined (e.g., studies with <15 patients). The collected data comprised of clinical background and indications, procedural aspects and types of PLI, and outcomes. In the form of a pictorial essay, each author illustrated a clinical case with CL and/or PLI.
Seven studies (corresponding to evidence level 4 [Oxford Centre for Evidence-Based Medicine]) accounting for 196 patients were included in the synthesis and analysis of data. Preceding surgery resulting in postoperative lymphorrhea included different surgical procedures such as extended oncologic surgery or vascular surgery. Central (e.g., chylothorax) and peripheral (e.g., lymphocele) types of postoperative lymphorrhea with a drainage volume of 100-4000 ml/day underwent CL with subsequent PLI. The intervals between "preceding surgery and CL" and between "CL and PLI" were 2-330 days and 0-5 days, respectively. CL was performed before PLI to visualize the lymphatic pathology (e.g., leakage point or inflow lymph ducts), applying fluoroscopy, radiography, and/or computed tomography (CT). In total, seven different types of PLI were identified: (1) thoracic duct (or thoracic inflow lymph duct) embolization, (2) thoracic duct (or thoracic inflow lymph duct) maceration, (3) leakage point direct embolization, (4) inflow lymph node interstitial embolization, (5) inflow lymph duct (other than thoracic) embolization, (6) inflow lymph duct (other than thoracic) maceration, and (7) transvenous retrograde lymph duct embolization. CL-associated and PLI-associated technical success rates were 97-100% and 89-100%, respectively. The clinical success rate of CL and PLI was 73-95%. CL-associated and PLI-associated major complication rates were 0-3% and 0-5%, respectively. The combined CL- and PLI-associated 30-day mortality rate was 0%, and the overall mortality rate was 3% (corresponding to six patients). In the pictorial essay, the spectrum of CL and/or PLI was illustrated.
The radiological management of postoperative lymphorrhea is feasible, safe, and effective. Standardized radiological treatments embedded in an interdisciplinary concept are a step towards improving outcomes.
术后淋巴液漏可发生于多种外科手术后，由于需要特定的治疗，可能会延长住院时间。本研究评估并阐述了术后淋巴液漏放射学管理的治疗意义。
在 PubMed 中，我们通过应用“lymphangiography”这一医学主题词（MeSH 术语）进行了文献的标准化检索。为了进行综述，纳入标准为“包含基于碘油的常规淋巴造影术（CL）和随后经皮淋巴介入术（PLI）的原始数据的研究”。同时，还定义了不同的排除标准（例如，纳入患者数<15 例的研究）。所收集的数据包括临床背景和适应证、操作步骤和 PLI 类型以及结果。每位作者以图片形式展示了一例 CL 和/或 PLI 临床病例。
共有 7 项研究（证据水平 4 [牛津循证医学中心]）纳入了对 196 例患者数据的综合分析。导致术后淋巴液漏的术前手术包括广泛的肿瘤切除术或血管手术等不同手术。中央型（如乳糜胸）和外周型（如淋巴囊肿）术后淋巴液漏，引流量为 100-4000ml/天，进行 CL 后行 PLI。“术前手术与 CL 之间”和“CL 与 PLI 之间”的时间间隔分别为 2-330 天和 0-5 天。CL 在透视、放射摄影和/或计算机断层扫描（CT）下进行，以可视化淋巴病理学（例如，漏点或流入淋巴管），并随后进行 PLI。共确定了七种不同类型的 PLI：（1）胸导管（或胸流入淋巴管）栓塞术；（2）胸导管（或胸流入淋巴管）糜灭术；（3）漏点直接栓塞术；（4）流入淋巴结间质栓塞术；（5）非胸导管（胸导管以外）栓塞术；（6）非胸导管（胸导管以外）糜灭术；以及（7）经静脉逆行淋巴管栓塞术。CL 相关和 PLI 相关的技术成功率分别为 97-100%和 89-100%，CL 和 PLI 的临床成功率分别为 73-95%。CL 相关和 PLI 相关的主要并发症发生率分别为 0-3%和 0-5%。30 天内 CL 和 PLI 联合相关死亡率为 0%，总死亡率为 3%（对应 6 例患者）。在图片中，展示了 CL 和/或 PLI 的范围。
术后淋巴液漏的放射学管理是可行、安全且有效的。纳入了跨学科概念的标准化放射治疗是改善预后的一个步骤。
