Lymphatic Intervention for Various Types of Lymphorrhea: Access and Treatment
Lymphatic Intervention for Various Types of Lymphorrhea: Access and Treatment
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DOI：
10.1148/rg.2016160053
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发表时间：
2016-11-01
期刊：
影响因子：
5.5
通讯作者：
Jinzaki, Masahiro
中科院分区：
文献类型：
--
作者：
Inoue, Masanori;Nakatsuka, Seishi;Jinzaki, Masahiro
创伤性淋巴漏是一种罕见但可能危及生命的并发症。术后淋巴漏是创伤性淋巴漏的主要原因，可发生在淋巴系统的任何部位。从髂动脉区到胸导管（TD）和肝动脉的渗漏可以分别通过结内淋巴管造影和经皮淋巴管造影来识别。因此，适当的淋巴管造影技术对于识别泄漏源至关重要。TD损伤导致的乳糜胸可能是严重的，因为TD从胃肠道、肝脏和髂动脉区域运输大量淋巴液。经皮TD栓塞-包括进入TD后栓塞-最近已成为一种微创替代手术TD结扎高输出乳糜胸。TD入路的选择取决于其解剖结构。如果不能通过这种方法接近TD，其他选择包括TD针中断或引流泄漏点附近的淋巴液，然后进行硬化治疗。大多数腹部淋巴漏来自髂髂淋巴系统，单独行淋巴管造影或CT引导下硬化治疗可能有用。罕见的情况下，由于胃十二指肠韧带受损，肝动脉破裂可能引起渗漏，可以通过经肝动脉可视化和栓塞。本文全面回顾了临床相关的解剖TD的变化，淋巴管造影技术和标准，他们的选择，和治疗策略的淋巴漏。(C)RSNA，2016 center dot radiographics.rsna.org
Traumatic lymphorrhea is a rare but potentially life-threatening complication. Postoperative lymphorrhea is the leading cause of traumatic lymphorrhea and can arise anywhere within the lymphatic system. Leaks arising from the aortoiliac region to the thoracic duct (TD) and from hepatic lymphatics can be identified with intranodal lymphangiography and transhepatic lymphangiography, respectively. Therefore, an appropriate lymphangiography technique is essential for identifying the sources of leaks. Chylothorax resulting from damage to the TD can be serious because the TD transports large amounts of lymphatic fluid from the gastrointestinal, hepatic, and aortoiliac regions. Percutaneous TD embolization-comprising access to the TD followed by embolization-has recently become a minimally invasive alternative to surgical TD ligation for high-output chylothorax. The selection of access routes to the TD depends on its anatomy. If the TD cannot be approached by such means, other options include TD needle interruption or drainage of lymphatic fluid adjacent to the leakage point followed by sclerotherapy. Most cases of abdominal lymphorrhea arise from the aorta-iliac lymphatic system, and lymphangiography alone or computed tomography-guided sclerotherapy might be useful. Rarely, leakage may arise from hepatic lymphatics due to a damaged gastroduodenal ligament and can be visualized and embolized transhepatically. This article comprehensively reviews clinically relevant anatomic TD variations, lymphangiography techniques and criteria for their selection, and treatment strategies for lymphorrhea. (C) RSNA, 2016 center dot radiographics.rsna.org