Othman Sammy, Azoury Saïd C, Klifto Kevin, Toyoda Yoshiko, Itkin Maxim, Kovach Stephen J
Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pa.
Section of Interventional Radiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pa.
Plast Reconstr Surg Glob Open. 2021 Oct 14;9(10):e3875. doi: 10.1097/GOX.0000000000003875. eCollection 2021 Oct.
Thoracic duct occlusion can lead to devastating complications, resulting in recalcitrant chylothoraces, ascites, generalized lymphedema, metabolic derangement, and death. Lymphatic extravasation has traditionally been managed conservatively and, in recent years, using minimally invasive techniques, such as thoracic duct ligation and embolization. However, these measures are often limited in application and therapeutic success, resulting in chronically difficult conditions with few modalities available for definitive management. Advances in microsurgery have allowed for surgical treatment and resolution of peripherally-based lymphatic pathology, though microsurgical intervention to address central lymphatic abnormalities is scarcely described. This report is the first series detailing experiences utilizing microsurgical thoracic duct lymphovenous bypass in a refractory adult population with thoracic duct occlusion. Four patients successfully underwent the procedure, with three achieving complete resolution of symptoms. The fourth patient enjoyed partial resolution, though ubiquitous lymphatic deformities have conferred recurrent residual lower-extremity peripheral edema requiring future intervention. Postoperatively, patent anastomoses were confirmed under magnetic resonance lymphangiography. This series demonstrates the feasibility of microsurgical thoracic duct lymphovenous bypass as a promising technique in treating patients suffering from thoracic duct occlusion. This intervention is effective for recalcitrant chylothorax, chylous ascites, and generalized lymphedema, particularly when traditional and interventional radiological techniques are unsuccessful.
胸导管闭塞可导致严重并发症，引发难治性乳糜胸、腹水、全身性淋巴水肿、代谢紊乱甚至死亡。传统上，淋巴外渗一直采用保守治疗，近年来则采用微创技术，如胸导管结扎和栓塞术。然而，这些措施的应用和治疗成功率往往有限，导致病情长期难以控制，可供确定性治疗的方法很少。显微外科的进展使得能够对外周性淋巴病变进行手术治疗并解决问题，不过针对中央淋巴异常的显微外科干预却鲜有报道。本报告是首个详细介绍在难治性成年胸导管闭塞患者中运用显微外科胸导管淋巴静脉旁路手术经验的系列报道。4例患者成功接受了该手术，其中3例症状完全缓解。第4例患者症状部分缓解，但其广泛存在的淋巴畸形导致下肢反复残留外周水肿，需要未来进一步干预。术后，磁共振淋巴管造影证实吻合口通畅。本系列研究证明了显微外科胸导管淋巴静脉旁路手术作为一种有前景的技术，用于治疗胸导管闭塞患者的可行性。这种干预措施对难治性乳糜胸、乳糜腹水和全身性淋巴水肿有效，尤其是在传统和介入放射学技术均失败的情况下。
