Department of Radiology, Ajou University Hospital, Suwon, Gyeonggi-do, Republic of Korea.
Br J Radiol. 2023 Sep;96(1149):20220831. doi: 10.1259/bjr.20220831. Epub 2023 Jul 3.
To assess lymphangiography findings and outcome of lymphatic embolisation to manage chyle leak after neck surgery.
Consecutive cases of lymphangiography performed between April 2018 and May 2022 for management of chyle leaks related to neck surgery were retrospectively reviewed. Lymphangiography findings, techniques, and outcomes were analysed.
Eight patients (mean age: 46.5 years) were included. Six patients had undergone radical neck dissection for thyroid cancer, and two had undergone lymph node excision. Clinical presentations were: chyle drainage through Jackson Pratt catheters in five patients, lymphorrhea through surgical wounds in two, and enlarging lymphocele in one. Lymphangiography techniques included: inguinal lymphangiography in four patients, retrograde lymphangiography in three, and transcervical lymphangiography in one. Lymphangiography revealed leaks in the terminal thoracic duct in two patients, bronchomediastinal trunk in two, jugular trunk in three, and superficial neck channels in one. Embolisation techniques included: non-selective embolisation of terminal thoracic duct ( = 2), selective embolisation of the jugular trunk ( = 3), selective embolisation of the bronchomediastinal trunk ( = 2), and intranodal glue embolisation of superficial neck channels ( = 1). One patient underwent a repeat procedure. Chyle leak resolved in all patients over a mean of 4.6 days. No complication was encountered.
Lymphatic embolisation seems to be effective and safe in managing chyle leaks after neck surgery. Lymphangiography allowed for the categorisation of chyle leaks according to their location. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.
Lymphatic embolisation is safe and effective in managing chyle leaks after neck surgery. On lymphangiography, the location of contrast media extravasation may not be consistent. The technique for embolisation should be based on the location of the leak. Post-embolisation patency of the thoracic duct may be preserved in chyle leaks that do not directly involve the thoracic duct.
评估淋巴管造影在颈部手术后处理乳糜漏中的作用和疗效。
回顾性分析 2018 年 4 月至 2022 年 5 月期间因颈部手术后乳糜漏而行淋巴管造影的连续病例。分析淋巴管造影表现、技术和结果。
共纳入 8 例患者（平均年龄：46.5 岁）。6 例患者因甲状腺癌行根治性颈清扫术，2 例患者行淋巴结切除术。临床表现为：5 例经 Jackson Pratt 引流管引流乳糜，2 例经手术伤口淋巴漏，1 例颈部淋巴结肿大。淋巴管造影技术包括：4 例腹股沟淋巴管造影，3 例逆行淋巴管造影，1 例经颈淋巴管造影。淋巴管造影显示 2 例患者胸导管末端漏，2 例支气管纵隔干漏，3 例颈静脉干漏，1 例颈部浅表通道漏。栓塞技术包括：2 例胸导管末端非选择性栓塞，3 例颈静脉干选择性栓塞，2 例支气管纵隔干选择性栓塞，1 例颈部浅表通道内淋巴结胶栓塞。1 例患者重复进行了该操作。所有患者的乳糜漏均在平均 4.6 天内得到缓解。未发生并发症。
淋巴管造影引导下的栓塞治疗颈部手术后乳糜漏是一种有效且安全的方法。淋巴管造影可根据漏出部位对乳糜漏进行分类。未直接累及胸导管的乳糜漏，其胸导管通畅性在栓塞后可能得到保留。
淋巴管造影引导下的栓塞治疗是治疗颈部手术后乳糜漏的一种安全有效的方法。在淋巴管造影中，造影剂外渗的部位可能不一致。栓塞技术应根据漏出部位来选择。未直接累及胸导管的乳糜漏，其胸导管通畅性在栓塞后可能得到保留。
