Applied Surgery and Metabolism Laboratory, School of Biological Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand.
Surgical and Translational Research Centre, Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Lymphology. 2022;55(3):86-109.
Thoracic duct drainage (TDD) is gaining renewed interest, largely due to accumulation of evidence supporting the gut-lymph model, where toxic mesenteric lymph from the intestine contributes to development of multi-organ failure in acute and critical illness (ACI). Advances in minimally invasive TDD have added to this growing interest. The English TDD literature has been previously reviewed, but the more extensive Eastern European literature has not been available to English readers. Therefore, we undertook a systematic search of Eastern European human TDD studies using Scopus and PubMed databases and Russian language websites. Indications for TDD, clinical outcomes, and complications were reviewed. 113 studies, published between 1965 and 2015, were reviewed. The most common indications for TDD were hepatic failure, acute pancreatitis, and peritonitis. It was often used late and when other treatment options had been exhausted. Human TDD appeared safe and probably effective, especially when combined with lymphosorption. The benefit appeared to correlate with the volume of lymph drained. A randomized controlled trial (and some case-control studies) showed reduced mortality in patients with ACI with TDD. Other benefits included rapid normalization of blood parameters and decreased organ edema. This review provides further support for the gut-lymph model and justification for high quality randomized controlled trials of TDD in ACI. It also highlights other potential indications for TDD, such as bridging patients with liver failure to surgery or transplant.
胸导管引流（TDD）再次受到关注，主要是因为越来越多的证据支持肠道-淋巴模型，即来自肠道的毒性肠系膜淋巴液有助于急性和危重病（ACI）中多器官衰竭的发展。微创 TDD 的进步也增加了人们对其的兴趣。英文 TDD 文献已经有过综述，但更广泛的东欧文献尚未为英语读者所获得。因此，我们使用 Scopus 和 PubMed 数据库以及俄语网站对东欧人类 TDD 研究进行了系统检索。回顾了 TDD 的适应证、临床结果和并发症。共检索到 1965 年至 2015 年间发表的 113 项研究。TDD 的最常见适应证是肝衰竭、急性胰腺炎和腹膜炎。它通常在其他治疗方法用尽后晚期使用。人类 TDD 似乎是安全的，而且可能有效，尤其是与淋巴吸附联合使用时。其益处似乎与引流的淋巴液量有关。一项随机对照试验（和一些病例对照研究）显示，ACI 患者接受 TDD 治疗可降低死亡率。其他益处包括血液参数迅速正常化和器官水肿减少。本综述进一步支持肠道-淋巴模型，并为 ACI 中 TDD 的高质量随机对照试验提供了依据。它还突出了 TDD 的其他潜在适应证，如为肝衰竭患者过渡到手术或移植搭桥。
