用于治疗胸部和颈部创伤性乳糜漏的结内及改良结内淋巴管造影术的疗效
Outcomes of Intranodal and Modified Intranodal Lymphangiography for Treatment of Traumatic Chylous Leaks in the Thorax and Neck.
作者信息
Parikh Rupal, Seyferth Elisabeth R, Palat Sanjay, Itkin Maxim, Nadolski Gregory J
机构信息
Division of Interventional Radiology, Department of Radiology, University of California San Diego School of Medicine, San Diego, CA, 92037, USA.
Division of Interventional Radiology, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
出版信息
Cardiovasc Intervent Radiol. 2025 Jan;48(1):59-64. doi: 10.1007/s00270-024-03900-z. Epub 2024 Dec 10.
PURPOSE
To report outcomes, procedure and fluoroscopy times, and adverse event rates after intranodal lymphangiography (IL) and modified IL (mIL) for treatment of traumatic chylous leaks in the thorax and neck.
METHODS
Under an IRB-approved protocol, retrospective review of a quality assurance database identified all lymphangiograms for post-surgical refractory chylous leaks in the thorax and neck at a tertiary center from 2002-2022. Records were reviewed for technical and clinical outcomes, procedure and fluoroscopy times, and adverse events. Pedal lymphangiograms were excluded. Patients were categorized into IL (pre-2016) and mIL (post-2016) cohorts. mIL incorporated pneumatic calf compression throughout the procedure. Technical success was defined as successful thoracic duct cannulation. Clinical success was defined as leak resolution and eventual chest or other drain removal within 2 weeks post-procedure. A two-tailed Fischer's exact test was used to compare categorical outcomes. A two-tailed t test was used to compare means.
RESULTS
Two hundred and thirty-nine patients underwent 263 thoracic duct embolizations of traumatic chylous leaks in the thorax/neck. Intranodal lymphangiography was used in 167 cases in 150 patients. Overall clinical success was 94.6% [n = 142/150]. Technical success was higher in mIL (94.2% [81/86]) than IL (76.5% [62/81]) (p = 0.002). Clinical success per patient and procedure were similar between cohorts (92.3% [72/78] mIL versus 97.2% [70/72] IL, p = 0.27, and 83.7% [72/86] mIL versus 85.1% [69/81] IL, p = 0.83, respectively). Mean procedure time in mIL (83.4 ± 31.9 min) was shorter than in IL (119.2 ± 45.9 min) (p < 0.0001). Mean fluoroscopy time in mIL (33.8 ± 17.3 min) was shorter than in IL (41.7 ± 23.2 min) (p = 0.02). Adverse event rate was not significantly different between groups.
CONCLUSION
Overall, thoracic duct embolization for traumatic chylothorax has high clinical success, approaching 95%. While clinical success of mIL was similar to IL, technical success and mean procedure and fluoroscopic times were significantly improved. Findings suggest modified intranodal lymphangiography should be utilized to treat traumatic chylothorax.
LEVEL OF EVIDENCE
Level 4, Case Series.
目的
报告经皮经肝穿刺胆管造影术（IL）和改良经皮经肝穿刺胆管造影术（mIL）治疗胸部和颈部创伤性乳糜漏后的治疗效果、操作及透视时间和不良事件发生率。
方法
根据机构审查委员会（IRB）批准的方案，对一个质量保证数据库进行回顾性分析，确定了2002年至2022年在一家三级中心接受手术治疗后难治性胸部和颈部乳糜漏的所有淋巴管造影病例。审查记录以获取技术和临床结果、操作及透视时间和不良事件。排除足背淋巴管造影。将患者分为IL组（2016年前）和mIL组（2016年后）。mIL在整个操作过程中采用气动小腿压迫。技术成功定义为胸导管插管成功。临床成功定义为漏口闭合且在术后2周内最终拔除胸腔或其他引流管。采用双侧Fisher精确检验比较分类结果。采用双侧t检验比较均值。
结果
239例患者接受了263次胸部/颈部创伤性乳糜漏的胸导管栓塞术。150例患者中的167例采用了经皮经肝穿刺胆管造影术。总体临床成功率为94.6%[n = 142/150]。mIL组的技术成功率（94.2%[81/86]）高于IL组（76.5%[62/81]）（p = 0.002）。两组患者的临床成功率和每次操作的临床成功率相似（mIL组为92.3%[72/78]，IL组为97.2%[70/7]，p = 0.27；mIL组为83.7%[72/86]，IL组为85.1%[69/81]，p = 0.83）。mIL组的平均操作时间（83.4±31.9分钟）短于IL组（119.2±45.9分钟）（p < 0.0001）。mIL组的平均透视时间（33.8±17.3分钟）短于IL组（41.7±23.2分钟）（p = 0.02）。两组的不良事件发生率无显著差异。
结论
总体而言，创伤性乳糜胸的胸导管栓塞术临床成功率高，接近95%。虽然mIL的临床成功率与IL相似，但技术成功率以及平均操作和透视时间均有显著改善。研究结果表明，改良经皮经肝穿刺胆管造影术应用于创伤性乳糜胸的治疗。
证据级别
4级，病例系列研究。
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