淋巴管造影指导治疗颈部乳糜痿

Treatment of cervical chylous Hstula under the guidance of lymphangiography

目的探讨淋巴管造影对诊断和治疗颈部乳糜痿的应用价值。方法回顾性分析2010年7月至2015年8月应用淋巴管造影诊断和治疗的7例颈部乳糜痿患者的临床资料。结果患者中男1例,女6例,年龄22-59岁。7例颈部乳糜痿患者行淋巴管造影均获得清晰动态成像,精确地显示了乳糜痿位置和胸导管解剖关系,2例患者可见胸导管经代偿支入血或主干入血,行保守治疗而痊愈,其他5例有明确造影剂漏出位置但未见明确造影剂入血,引流量仍大于500 ml/d,行手术治疗痊愈。所有患者均未出现并发症。结论淋巴管造影不仅可清晰定位乳糜痿漏口和胸导管走行及解剖关系,而且能指导选择治疗方式和精准手术,有效地避免术中探查导致的二次损伤。

Objective To investigate the clinical value of lymphangiography in the diagnosis and treatment of cervical chylous fistula.Methods The clinical data of 7 patients with chylous fistula at Department of Lymph Surgery,Capital Medical University Affiliated Beijing Shijitan Hospital from Jul 2010 to Aug 2015 was retrospectively analyzed.Lymphangiography was performed to investigate the site of fistula and condition of thoracic duct.Results There were 1 male and 6 female patients aging from 22 to 59 years.All patients underwent lymphangiography successfully with dynamic imaging clearly,which accurately showed the location of the leakage and the anatomy of the thoracic duct.There was compensatory branch or trunk drainage in 2 cases which underwent successful conservative treatment,the other 5 cases with leak>500 ml a day without clear compensatory branch underwent surgical treatment and were cured with no major complications.Conclusion Lymphangiography not only clearly locates the leakage and anatomical relationship of the thoracic duct,but also guides the choice of treatment and precise surgery,avoiding the secondary injury.