Department of Pediatric Cardiology, Fukuoka Children's Hospital, 5-1-1 Kashiiteriha Higashi-ku, Fukuoka, 813-0017, Japan.
Division of Pediatrics, Department of Developmental and Urological-Reproductive Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki, 889-1692, Japan.
Pediatr Cardiol. 2024 Jan;45(1):150-155. doi: 10.1007/s00246-023-03303-w. Epub 2023 Oct 23.
Postoperative chylothorax in patients with congenital heart diseases (CHD) results in poor outcomes if anatomical and functional abnormalities of the lymphatic system are present. While these abnormalities are typically diagnosed by intranodal lymphangiography and dynamic contrast magnetic resonance lymphangiography, the usefulness of lymphoscintigraphy in these patients has not been evaluated. Between January 2019 and December 2021, 28 lymphoscintigraphies were performed in our institution for investigating prolonged pleural effusion after cardiac surgery. The images were assessed by three board-certified pediatric cardiologists retrospectively to determine the likelihood of a central lymphatic flow disorder. The likelihood was scored (range 1-3) based on structural abnormalities and congestive flow in the lymphatic system. Those scores were summed and the likelihood was categorized as low to intermediate (< 8 points) or high (8 or 9 points). Median age at lymphoscintigraphy was 129 days (IQR, 41-412 days), it was performed at a median of 22 days (IQR, 17-43) after surgery, and median score was 6 points (IQR, 4-7.5). Kendall's coefficient of concordance (0.867; p < 0.05) indicated high inter-rater reliability. Overall survival at 6 months after surgery was 92.5% in the low-to-intermediate group but 68.6% in the high group (p < 0.05), and duration of postoperative thoracic drainage was 27 and 58 days, respectively (p < 0.05). Lymphatic abnormalities detected by lymphoscintigraphy were associated with poorer outcomes. Lymphoscintigraphy was thought to be useful in assessing anatomic and functional lymphatic abnormalities, despite its minimal invasiveness.
在存在淋巴管系统解剖和功能异常的情况下，先天性心脏病（CHD）患者术后乳糜胸会导致不良结局。虽然这些异常通常通过淋巴结内淋巴管造影和动态对比磁共振淋巴造影来诊断，但淋巴闪烁显像术在这些患者中的应用尚未得到评估。2019 年 1 月至 2021 年 12 月，我院对心脏手术后持续性胸腔积液的 28 例患者进行了淋巴闪烁显像术检查。由 3 名具有小儿心脏病学认证的医师对图像进行回顾性评估，以确定中央淋巴液流动障碍的可能性。根据淋巴管系统的结构异常和充血性血流情况对可能性进行评分（范围 1-3）。将这些评分相加，并将可能性分为低到中等（<8 分）或高（8 或 9 分）。淋巴闪烁显像术的中位年龄为 129 天（IQR，41-412 天），中位时间为手术后 22 天（IQR，17-43 天），中位数为 6 分（IQR，4-7.5）。Kendall 一致性系数（0.867;p<0.05）表明评分者间的高度一致性。低到中等组手术后 6 个月的总生存率为 92.5%，而高组为 68.6%（p<0.05），术后胸腔引流时间分别为 27 天和 58 天（p<0.05）。淋巴闪烁显像术检测到的淋巴异常与不良结局相关。尽管淋巴闪烁显像术具有微创性，但它被认为对评估解剖和功能淋巴异常有用。
