淋巴管造影在指导创伤性乳糜漏诊治中的研究

Lymphangiography for diagnosis and treatment of traumatic chylous leak: a preliminary report

目的总结足背淋巴管造影指导13例创伤性乳糜漏的诊治作用,以提高对创伤性乳糜漏患者的治疗水平。方法对2008年5月至2019年1月期间上海浦南医院对初期采用保守治疗5-14 d无效的12例外科手术后和1例胸部挤压伤后乳糜漏患者准备再次手术治疗前进行单侧足背淋巴管造影,根据足背淋巴管造影结果重新评估治疗方法。结果对足背淋巴管造影明确乳糜漏口5例患者采用手术措施,获得治愈,在3例明确乳糜漏口和4例未能显示乳糜漏口的患者中,由于淋巴管造影后乳糜引流量明显减少,采用继续保守治疗7-45 d而愈,1例胸部挤压伤未能显示乳糜漏口,继续保守治疗病情恶化,再次手术后死亡。结论对保守治疗无效的创伤性乳糜漏患者准备再次手术治疗前行足背淋巴管造影可以明确乳糜漏口的位置,有利于提高手术的成功率。对淋巴管造影后乳糜漏量有减少者,无论是否确定乳糜漏口均可继续采用保守治疗。对不能明确显示乳糜漏口的患者再次手术有一定的盲目性,难以达到理想的治疗效果。

Objective To investigate the diagnostic and therapeutic roles of lymphangiography in 13 patients with traumatic chylous fistula to improve the treatment of this disease. Methods Twelve cases of postoperative chylous leakage after initial conservative treatment for 5-14 days and one case of chylous leakage after chest compression injury treated at Shanghai Pudong Hospital from May 2008 to January 2019 were enrolled in this study. Unilateral dorsal foot lymphangiography was performed in all 13 cases before reoperation, and the treatment method was re-evaluated according to the results of lymphangiography. Results Chyle leakage was observed in eight cases according to dorsal foot lymphangiography, and five of them were cured by surgery. The other three cases with chyle leakage and four cases who failed to show chyle leakage were cured by conservative treatment(7-45 days), since chyle flow decreased significantly after lymphography. The case of chest compression injury who failed to show chylous leak had deteriorated disease after conservative treatment and died after reoperation. Conclusion The location of chylous leak can be determined by lymphangiography of the anterior foot back, which is conducive to improving the success rate of surgery. For patients with reduced chylous leak after lymphangiography, conservative treatment can be continued regardless of whether the chylous leak is confirmed or fails to be shown. It is difficult to achieve the ideal therapeutic effect because of the blindness of reoperation for patients who cannot clearly show chylous leak.