Koester Trever M, Chewning Rush H, Weldon Christopher B, Shaikh Raja, Weil Brent R
Harvard Medical School, 25 Shattuck Street, Boston, MA, USA.
Harvard Medical School, 25 Shattuck Street, Boston, MA, USA; Division of Interventional Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, USA.
J Pediatr Surg. 2023 Nov;58(11):2141-2148. doi: 10.1016/j.jpedsurg.2023.05.016. Epub 2023 May 25.
Chyle leaks are a common post-operative complication following solid-tumor resection in pediatric patients. Current treatments for persistent chyle leaks are limited, leading many patients to experience prolonged hospitalization, nutritional deficits and/or delays in cancer therapies. Lymphatic embolization is an emerging treatment option for chyle leaks, however, limited reports exist of its use in pediatric populations.
We conducted a retrospective review of pediatric patients (<18) who underwent lymphangiogram with intent for lymphatic embolization for the management of chyle leaks following solid-tumor resection between 2017 and 2022.
Seven patients underwent a total of 11 attempted lymphatic embolization procedures after current standard of care treatments failed to resolve the leak. Lymphangiograms identified a chyle leak in 6 of 7 patients and embolization had a technical success rate of 73%. The complication rate was 9% and complications were limited to one episode of inadvertent gastric wall perforation that did not result in a gastric leak. Lymphatic embolization was ultimately associated with chyle leak resolution in 100% of patients within a median of 24 days, however, repeat embolization was required in 5 of 7 patients (83%).
Lymphatic embolization appears to be a safe and effective treatment for persistent chyle leaks in pediatric patients, leads to a direction reduction in chyle output, and has high rates of technical and clinical success. Complete resolution of the chyle leak may require multiple embolization procedures. Further work is needed to determine whether earlier intervention may offer benefit for the management of pediatric chyle leaks.
IV.
乳糜漏是小儿实体瘤切除术后常见的术后并发症。目前针对持续性乳糜漏的治疗方法有限，导致许多患者住院时间延长、出现营养缺乏和/或癌症治疗延迟。淋巴管栓塞术是一种新兴的乳糜漏治疗选择，然而，其在儿科患者中的应用报道有限。
我们对2017年至2022年间因实体瘤切除术后乳糜漏而接受淋巴管造影并意图进行淋巴管栓塞术的18岁以下儿科患者进行了回顾性研究。
7例患者在当前标准治疗未能解决漏液问题后，共尝试了11次淋巴管栓塞术。淋巴管造影在7例患者中的6例中发现了乳糜漏，栓塞术的技术成功率为73%。并发症发生率为9%，并发症仅限于1例意外胃壁穿孔，未导致胃漏。淋巴管栓塞术最终在中位24天内使100%的患者乳糜漏得到解决，然而，7例患者中有5例（83%）需要重复栓塞。
淋巴管栓塞术似乎是治疗小儿持续性乳糜漏的一种安全有效的方法，可使乳糜输出量明显减少，技术和临床成功率高。乳糜漏的完全解决可能需要多次栓塞手术。需要进一步开展工作以确定早期干预是否对小儿乳糜漏的管理有益。
IV级。
