Lee Kyungmin, Chang Suk-Joon, Won Je Hwan, Kwon Yohan, Kim Seong Ho, Kim Jeong-Eun, Kim Jinoo
Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Obstetrics and Gynecology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea.
J Vasc Interv Radiol. 2023 Apr;34(4):591-599.e1. doi: 10.1016/j.jvir.2022.12.020. Epub 2022 Dec 13.
To assess outcome and predictors of outcome after lymphatic embolization (LE) for early postoperative lymphatic leak after pelvic surgery.
Lymphangiography (LG) procedures performed between May 2015 and February 2020 for postoperative intraperitoneal lymphatic leaks after pelvic surgery were reviewed. Treatment indication was lymphatic drainage of >500 mL/d persisting for >1 week. LE was performed by injecting glue into the iliac lymph node. Fisher exact and Wilcoxon rank-sum tests were used for comparative analysis, and logistic regression was used to assess predictors of outcome.
LG was performed in 71 patients. A leak was demonstrated in 69 patients who underwent LE. The mean drainage was 1,329 mL/d ± 773. Catheters were removed in 49 (69.0%) patients after 1 procedure and in 69 (97.2%) patients after a mean of 1.3 procedures. The mean drainage at the time of catheter removal was 157 mL/d ± 100. Failure occurred in 12 (16.9%) cases, including 2 (2.8%) cases of unsuccessful catheter removal and 10 (14.1%) cases of catheter reinsertion owing to recurrent ascites (n = 3) and lymphoceles (n = 7). Older age and drainage of >1,500 mL/d were associated with failure (P = .004). Drainage of >1,500 mL/d was associated with a post-LE catheter dwell time of longer than 1 week (P = .024). Minor adverse events were noted in 4 (5.6%) patients who presented with transient leg swelling.
LE was effective for treating pelvic surgery-related lymphatic leaks. Reintervention may be required. Drainage of >1,500 mL/d was associated with clinical failure and a post-LE catheter dwell time of longer than 1 week.
评估盆腔手术后早期淋巴漏行淋巴管栓塞术（LE）后的疗效及疗效预测因素。
回顾2015年5月至2020年2月间因盆腔手术后腹腔内淋巴漏而行的淋巴管造影（LG）操作。治疗指征为淋巴引流量>500 mL/d持续>1周。通过向髂淋巴结注射胶水进行LE。采用Fisher精确检验和Wilcoxon秩和检验进行比较分析，并采用逻辑回归评估疗效预测因素。
71例患者接受了LG检查。69例行LE的患者发现有淋巴漏。平均引流量为1329 mL/d±773。49例（69.0%）患者在1次操作后拔除导管，69例（97.2%）患者平均在1.3次操作后拔除导管。拔除导管时的平均引流量为157 mL/d±100。12例（16.9%）出现失败，包括2例（2.8%）导管拔除未成功，10例（14.1%）因复发性腹水（n = 3）和淋巴囊肿（n = 7）而再次插入导管。年龄较大和引流量>1500 mL/d与失败相关（P = 0.004）。引流量>1500 mL/d与LE后导管留置时间超过1周相关（P = 0.024）。4例（5.6%）出现短暂腿部肿胀的患者出现轻微不良事件。
LE治疗盆腔手术相关淋巴漏有效。可能需要再次干预。引流量>1500 mL/d与临床失败及LE后导管留置时间超过1周相关。
