先天性和术后乳糜胸的处理：胸腔镜淋巴漏结扎术联合术中吲哚菁绿淋巴管造影术的应用。

Management of Congenital and Postoperative Chylothorax: Use of Thoracoscopic Lymphatic Leak Ligations with Intraoperative ICG Lymphangiography.

机构信息

Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

J Pediatr Surg. 2023 Sep;58(9):1754-1761. doi: 10.1016/j.jpedsurg.2022.11.018. Epub 2022 Dec 5.

DOI:10.1016/j.jpedsurg.2022.11.018

PMID:36609065

Abstract

BACKGROUND

Congenital chylothorax (CCT) and postoperative chylothorax (POCT) are rare and difficult to treat. We report our treatment strategy and outcomes for chylothorax, including thoracoscopic surgery with indocyanine-green (ICG) near-infrared fluorescence lymphangiography.

METHODS

A retrospective review of patients with CCT and POCT from 2014 to 2021 was performed. After definitive diagnosis, conservative treatments with octreotide, followed by intravenous steroids as needed, were performed. Patients who were refractory to conservative treatment were transferred to surgical treatment, consisting of thoracoscopic lymphatic leak ligations using ICG intraoperative lymphangiography. The effectiveness of conservative and surgical treatment was then examined.

RESULTS

We included 19 cases of CCT and 31 cases of POCT. The 31 POCT patients included 23 of 84 postoperative patients with congenital diaphragmatic hernia (CDH), 7 of 54 postoperative patients with esophageal atresia (EA), and 1 of 3 postoperative patients with lymphatic malformation. The efficacy of conservative treatment was 12/19 for CCT, 22/23 for CDH, and 4/7 for EA. Surgical intervention was performed in 10 patients, and the rate of resolution of chylothorax within 3 weeks after surgery was 90%.

CONCLUSION

Thoracoscopic lymphatic leak ligations with intraoperative ICG lymphangiography are feasible and useful in patients with chylothorax refractory to conservative treatment.

LEVEL OF EVIDENCE

Level IV.

摘要

背景

先天性乳糜胸（CCT）和术后乳糜胸（POCT）较为罕见，且治疗难度较大。我们报告了使用吲哚菁绿（ICG）近红外荧光淋巴管造影行胸腔镜手术治疗乳糜胸的治疗策略和结果。

方法

回顾性分析了 2014 年至 2021 年期间患有 CCT 和 POCT 的患者。确诊后，先采用奥曲肽进行保守治疗，必要时静脉内给予类固醇。对保守治疗无效的患者转至外科治疗，使用 ICG 术中淋巴管造影行胸腔镜下淋巴管漏结扎术。然后检查保守和手术治疗的效果。

结果

共纳入 19 例 CCT 患者和 31 例 POCT 患者。31 例 POCT 患者中，23 例为先天性膈疝（CDH）术后 84 例患者中的患者，7 例为食管闭锁（EA）术后 54 例患者中的患者，1 例为淋巴管畸形术后 3 例患者中的患者。CCT 的保守治疗有效率为 12/19，CDH 的保守治疗有效率为 22/23，EA 的保守治疗有效率为 4/7。对 10 例患者进行了手术干预，术后 3 周内乳糜胸缓解率为 90%。