Yan Rong, Gao Shan, Xia Peng
First Affiliated Hospital of Xi'an Jiaotong University Xi'an, Shaanxi, China.
School of Medicine, Xi'an Jiaotong University Xi'an, Shaanxi, China.
Am J Transl Res. 2025 Aug 15;17(8):6610-6618. doi: 10.62347/XINP3272. eCollection 2025.
Chylothorax, a rare and severe complication of esophageal cancer surgery, results from damage to the lymphatic system. We report on a 70-year-old female with esophageal cancer and a history of poorly managed diabetes who developed high-flow chylothorax following esophagectomy. Initial conservative measures, including pleural drainage, lymph production reduction medication, and nutritional support, failed to improve her condition. Subsequent surgical attempts to ligate the thoracic duct were also unsuccessful due to extensive pleural adhesions. This led to a referral for percutaneous thoracic duct embolization (TDE). At another medical facility, the patient underwent lymphangiography, cisterna chyli puncture embolization, and cavity puncture drainage. The TDE successfully embolized the thoracic duct, markedly reducing the leakage of chylous fluid. Subsequent CT scans and follow-up assessments confirmed the patient's recovery with no recurrence of chylothorax. This case illustrates the complexities of managing post-esophagectomy chylothorax and highlights the importance of individualized treatment strategies. It also emphasizes the potential of minimally invasive TDE as an effective alternative for treatment-resistant chylothorax cases.
乳糜胸是食管癌手术罕见且严重的并发症，由淋巴系统受损引起。我们报告一例70岁女性食管癌患者，有糖尿病控制不佳病史，在食管切除术后发生高流量乳糜胸。最初的保守措施，包括胸腔引流、减少淋巴生成的药物治疗和营养支持，均未能改善她的病情。由于广泛的胸膜粘连，随后结扎胸导管的手术尝试也未成功。这导致患者被转诊进行经皮胸导管栓塞术（TDE）。在另一家医疗机构，患者接受了淋巴管造影、乳糜池穿刺栓塞和胸腔穿刺引流。TDE成功栓塞了胸导管，显著减少了乳糜液的漏出。随后的CT扫描和随访评估证实患者康复，乳糜胸未复发。该病例说明了食管切除术后乳糜胸管理的复杂性，突出了个体化治疗策略的重要性。它还强调了微创TDE作为治疗难治性乳糜胸病例有效替代方法的潜力。
