经皮淋巴结穿刺淋巴造影术对乳糜漏的诊治效果

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目的:评估经皮淋巴结穿刺淋巴造影术对乳糜漏的诊治效果。方法:回顾性分析2019年1月至11月中国医学科学院肿瘤医院8例乳糜漏患者资料,男5例,女3例,中位年龄64岁,医源性乳糜胸4例,医源性乳糜腹3例,不明原因乳糜腹1例。8例患者均在超声引导下穿刺腹股沟淋巴结,注入对比剂碘化油行淋巴造影术。观察其操作相关并发症情况,并随访其疗效。结果:8例患者经皮淋巴结穿刺淋巴造影术均获得技术成功,中位碘化油用量17.5 ml,中位手术时间88 min,无造影相关并发症发生。5例(5/8)经皮淋巴结穿刺淋巴造影诊断乳糜漏阳性,其中4例(4/4)乳糜胸患者造影均为阳性,见胸导管不同水平对比剂外溢;1例(1/4)乳糜腹造影阳性,为胰腺癌术后患者,腰3~4椎体水平见对比剂外溢。5例(5/8)经皮淋巴结穿刺淋巴造影治疗乳糜漏有效,其中乳糜胸患者3例,乳糜腹患者2例。结论:经皮淋巴结穿刺淋巴造影术是诊断乳糜漏的安全、有效的淋巴造影方法,兼具治疗乳糜漏的效果。“,”Objective:To evaluate the diagnostic and therapeutic effect of percutaneous intranodal lymphography in patient with chylous leakage.Methods:The clinical data of percutaneous intranodal lymphography in patients with chylous leakage from January 2019 to November 2019 in Cancer Hospital Chinese Academy of Medical Sciences were retrospectively analyzed. A total of 8 patients (5 males and 3 females, median age 64 years old) were enrolled. Four patients were iatrogenic chylothorax, 3 patients iatrogenic chyloperitoneum, and 1 patient chyloperitoneum with unknown cause. All 8 patients were received inguinal lymph nodes puncture under ultrasound guidance, and contrast agent iodinated oil was injected for lymphography. The procedure complications were recorded and the follow-up data were collected for efficacy assessment.Results:The percutaneous intranodal lymphography was successfully performed in all patients (8/8). The median amount of iodinated oil used was 17.5 ml; the median operation time was 88 min, without complications found during the procedure. The results of percutaneous intranodal lymphography was positive in 5/8 cases, of which chylothorax and chyloperitoneum was 4/4 and 1/4, respectively. Four cases with chylothorax showed contrast extravasation at different level of thoracic duct, and 1 case after pancreatic cancer resection showed contrast extravasation at L3-4 level. The chylous leakage was treated in 5 patients (5/8) during and resolved after percutaneous intranodal lymphography, with 3 chylothorax and 2 chyloperitoneum cases, respectively.Conclusion:Percutaneous intranodal lymphography is a safe and effective lymphography method for the diagnosis of chylous leakage, and also has application values in the treatment of chylous leakage.
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