经左静脉角逆行胸导管入路介入治疗乳糜胸的疗效分析

Retrograde thoracic duct approach via left venous angle in the treatment of chylothorax

目的:探讨经左静脉角逆行胸导管入路乳糜胸介入治疗的可行性及效果分析。方法:回顾性分析2019年7月至2021年4月同济大学附属上海市肺科医院收治的16例乳糜胸患者临床资料。所有患者均接受经皮腹股沟结内淋巴管造影术,并尝试经左静脉角逆行胸导管超选择性插管,成功插管的患者行逆行胸导管直接造影,显示胸导管破裂口位置后用微弹簧圈和组织胶栓塞。结果:16例患者的腹股沟结内淋巴管造影均获得成功,胸导管末端显示开放良好。所有患者均尝试行经左静脉角逆行胸导管超选择性插管,插管成功10例,其中6例造影中显示明显对比剂外溢,用微弹簧圈结合组织胶栓塞胸导管。所有16例患者术后乳糜胸均有好转,6例完全治愈。所有患者均无严重并发症。结论:经左静脉角逆行胸导管入路行乳糜胸介入治疗是有效可行的方法。

Objective To investigate the feasibility and effect of retrograde thoracic duct approach via left venous angle in the treatment of chylothorax.Methods From July 2019 to April 2021,the clinical data of 16 patients with chylothorax in Shanghai Pulmonary Hospital Tongji University were retrospectively collected.All patients underwent percutaneous inguinal lymphography,super selective retrograde thoracic duct catheterization was attempted via the left venous angle.Successful patients underwent direct thoracic ductography.After the position of the rupture was shown,the thoracic duct was embolized with microcoils and glue.Results The inguinal lymphography of 16 patients was successful,and the end of thoracic ducts was identified.Retrograde thoracic duct catheterizations were successful in 10 patients,6 cases showed contrast agent overflow in thoracic ductography,and the thoracic ducts were embolized using microcoils combined with glue.Chylothorax was improved in 16 patients,and 6 cases were completely cured.All patients had no serious complications.Conclusion It is an effective and feasible method to treat chylothorax by retrograde thoracic ductography and embolization approach via left venous angle.