Division for Minimally-Invasive Lymph Vessel Therapy, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Bonn, Germany.
Clin Exp Med. 2024 Mar 30;24(1):63. doi: 10.1007/s10238-024-01312-4.
To report results of interventional treatment of refractory non-traumatic abdomino-thoracic chylous effusions in patients with lymphoproliferative disorders. 17 patients (10 male; mean age 66.7 years) with lymphoproliferative disorders suffered from non-traumatic chylous effusions (chylothorax n = 11, chylous ascites n = 3, combined abdomino-thoracic effusion n = 3) refractory to chemotherapy and conservative therapy. All underwent x-ray lymphangiography with iodized-oil to evaluate for and at the same time treat lymphatic abnormalities (leakage, chylo-lymphatic reflux with/without obstruction of central drainage). In patients with identifiable active leakage additional lymph-vessel embolization was performed. Resolution of effusions was deemed as clinical success. Lymphangiography showed reflux in 8/17 (47%), leakage in 2/17 (11.8%), combined leakage and reflux in 3/17 (17.6%), lymphatic obstruction in 2/17 (11.8%) and normal findings in 2/17 cases (11.8%). 12/17 patients (70.6%) were treated by lymphangiography alone; 5/17 (29.4%) with leakage received additional embolization (all technically successful). Effusions resolved in 15/17 cases (88.2%); 10/12 (83.3%) resolved after lymphangiography alone and in 5/5 patients (100%) after embolization. Time-to-resolution of leakage was significantly shorter after embolization (within one day in all cases) than lymphangiography (median 9 [range 4-30] days; p = 0.001). There was no recurrence of symptoms or post-interventional complications during follow-up (median 445 [40-1555] days). Interventional-radiological treatment of refractory, non-traumatic lymphoma-induced chylous effusions is safe and effective. Lymphangiography identifies lymphatic abnormalities in the majority of patients and leads to resolution of effusions in > 80% of cases. Active leakage is found in only a third of patients and can be managed by additional embolization.
报告介入治疗非创伤性胸腹部乳糜性积液的结果，这些患者患有淋巴增生性疾病。17 例（男 10 例；平均年龄 66.7 岁）患有淋巴增生性疾病，患有非创伤性乳糜性积液（乳糜胸 11 例，乳糜性腹水 3 例，胸腹联合积液 3 例），对化疗和保守治疗均有抗性。所有患者均接受碘化油 X 射线淋巴管造影术，以评估并同时治疗淋巴管异常（渗漏、有/无中央引流阻塞的乳糜淋巴反流）。对于可识别的活动性渗漏，另外进行淋巴管栓塞术。积液消退被认为是临床成功。淋巴管造影显示反流 8/17 例（47%），渗漏 2/17 例（11.8%），渗漏和反流合并 3/17 例（17.6%），淋巴管阻塞 2/17 例（11.8%），正常发现 2/17 例（11.8%）。17 例患者中有 12 例（70.6%）仅接受淋巴管造影术治疗；5 例（29.4%）渗漏患者接受了额外的栓塞术（均为技术成功）。17 例患者中有 15 例（88.2%）积液消退；12 例（83.3%）仅接受淋巴管造影术消退，5 例（100%）接受栓塞术消退。栓塞术后渗漏的消退时间明显短于淋巴管造影术（所有病例均在一天内）（中位数 9 [范围 4-30] 天；p=0.001）。在随访期间（中位数 445 [40-1555] 天）没有症状或介入后并发症复发。介入放射治疗复发性非创伤性淋巴瘤引起的乳糜性积液是安全有效的。淋巴管造影术在大多数患者中识别出淋巴管异常，并导致 80%以上的病例的积液消退。仅三分之一的患者存在活动性渗漏，可以通过额外的栓塞术来治疗。
