介入治疗乳糜漏60例的临床疗效分析

Interventional treatment of chylous leakage in 60 cases: a preliminary study

目的评价介入治疗乳糜漏的可行性、安全性、治疗效果, 以及个体化手术方式的选择。方法回顾性分析2019年6月至2022年1月郑州大学第一附属医院放射介入科收治的60例乳糜漏患者临床资料, 包括乳糜胸37例、乳糜腹10例、乳糜尿4例、乳糜胸合并乳糜腹5例、乳糜胸合并心包积液2例、盆腔乳糜性积液2例。所有患者均保守治疗失败。患者均先行淋巴管造影, 而后根据造影结果选择个体化手术方式。术后统计治疗效果和并发症, 并进行随访。结果淋巴造影成功55例, 5例患者乳糜池和胸导管未见显影, 造影成功率91.7%。单纯淋巴管造影23例、胸导管栓塞23例、乳糜池胸导管针刺毁损5例、直接淋巴管栓塞4例、胸导管球囊扩张成形5例。治疗后痊愈39例(65.0%)、有效14例(23.3%)、无效7例(11.7%), 总体有效率88.3%(53/60)。并发症发生率8.3%(5/60), 均为轻症并发症。失访患者4例, 完成随访者56例, 随访时长0.5~30个月, 中位随访时间为11个月。随访期间病情复发1例(2.0%, 1/49)、死亡8例。结论介入治疗乳糜漏安全、有效、并发症低。根据淋巴造影结果选择个体化手术方式, 合理可行, 疗效良好。

Objective To evaluate the feasibility,safety,treatment outcome,and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods From July 2019 to January 2022,the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed.The cases included chylothorax(n=37),chylous ascites(n=10),chyluria(n=4),chylothorax combined with chylous ascites(n=5),chylothorax combined with chylopericardium(n=2),and pelvic chylous effusion(n=2).Conservative treatment was considered to have failed for all patients.The lymphangiography was firstly performed to detect chylous leakage,then an individualized procedure was selected according to the lymphangiography results.The treatment outcomes and complications were recorded,and follow-up was performed.Results Lymphangiography was technically successful in 55 of 60 patients(91.7%),and no cisterna chyli and thoracic duct opacification was observed in 5 patients.The procedures for the patients included lymphangiography alone(n=23),thoracic duct embolization(n=23),thoracic duct disruption(n=5),lymphatic embolization for pelvic chylous effusion(n=4),and balloon plasty for thoracic duct(n=5).Clinical success was achieved in 53 of 60 cases(88.3%).The complication rate was 8.3%(5/60),and all complications were minor.The median follow-up time was 11 months(range 0.5-30 months)for 56 patients,and 4 patients were lost to follow-up.There was one patient presenting the reoccurrence of symptom,and 8 patients died.Conclusions The interventional treatment of chylous leakage is safe with good outcomes and low complication rate.Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.