Rupal Parikh, Elisabeth R Seyferth, Sanjay Palat, Maxim Itkin, Gregory J Nadolski
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引用次数: 0
Abstract
Purpose: To report outcomes, procedure and fluoroscopy times, and adverse event rates after intranodal lymphangiography (IL) and modified IL (mIL) for treatment of traumatic chylous leaks in the thorax and neck.
Methods: Under an IRB-approved protocol, retrospective review of a quality assurance database identified all lymphangiograms for post-surgical refractory chylous leaks in the thorax and neck at a tertiary center from 2002-2022. Records were reviewed for technical and clinical outcomes, procedure and fluoroscopy times, and adverse events. Pedal lymphangiograms were excluded. Patients were categorized into IL (pre-2016) and mIL (post-2016) cohorts. mIL incorporated pneumatic calf compression throughout the procedure. Technical success was defined as successful thoracic duct cannulation. Clinical success was defined as leak resolution and eventual chest or other drain removal within 2 weeks post-procedure. A two-tailed Fischer's exact test was used to compare categorical outcomes. A two-tailed t test was used to compare means.
Results: Two hundred and thirty-nine patients underwent 263 thoracic duct embolizations of traumatic chylous leaks in the thorax/neck. Intranodal lymphangiography was used in 167 cases in 150 patients. Overall clinical success was 94.6% [n = 142/150]. Technical success was higher in mIL (94.2% [81/86]) than IL (76.5% [62/81]) (p = 0.002). Clinical success per patient and procedure were similar between cohorts (92.3% [72/78] mIL versus 97.2% [70/72] IL, p = 0.27, and 83.7% [72/86] mIL versus 85.1% [69/81] IL, p = 0.83, respectively). Mean procedure time in mIL (83.4 ± 31.9 min) was shorter than in IL (119.2 ± 45.9 min) (p < 0.0001). Mean fluoroscopy time in mIL (33.8 ± 17.3 min) was shorter than in IL (41.7 ± 23.2 min) (p = 0.02). Adverse event rate was not significantly different between groups.
Conclusion: Overall, thoracic duct embolization for traumatic chylothorax has high clinical success, approaching 95%. While clinical success of mIL was similar to IL, technical success and mean procedure and fluoroscopic times were significantly improved. Findings suggest modified intranodal lymphangiography should be utilized to treat traumatic chylothorax.
目的：报告结内淋巴管造影（IL）和改良IL （mIL）治疗胸颈部外伤性乳糜漏的结果、程序和透视次数以及不良事件发生率。方法：根据irb批准的方案，回顾性审查质量保证数据库，确定2002-2022年三级中心胸部和颈部术后难治性乳糜漏的所有淋巴管造影。回顾了技术和临床结果、手术和透视时间以及不良事件的记录。排除足部淋巴管造影。患者被分为IL（2016年前）和mIL（2016年后）两组。在整个过程中，mIL采用了气动小腿压缩。技术上的成功定义为成功的胸导管插管。临床成功定义为在术后2周内解决泄漏并最终清除胸腔或其他引流管。采用双尾Fischer精确检验比较分类结果。采用双尾t检验比较均数。结果：239例患者接受了263次胸/颈外伤性乳糜漏胸导管栓塞治疗。150例167例采用结内淋巴管造影。临床总成功率为94.6% [n = 142/150]。mIL组的技术成功率（94.2%[81/86]）高于IL组（76.5% [62/81]）（p = 0.002）。每名患者和手术的临床成功率在队列之间相似（92.3% [72/78]mIL vs 97.2% [70/72] IL, p = 0.27; 83.7% [72/86] mIL vs 85.1% [69/81] IL, p = 0.83）。mIL组的平均手术时间（83.4±31.9 min）短于IL组（119.2±45.9 min） (p)。结论：总体而言，胸导管栓塞治疗外伤性乳糜胸的临床成功率较高，接近95%。虽然mIL的临床成功率与IL相似，但技术成功率、平均程序和透视时间显着提高。结果提示改良结内淋巴管造影应用于治疗外伤性乳糜胸。证据级别：4级，案例系列。
期刊介绍：
CardioVascular and Interventional Radiology (CVIR) is the official journal of the Cardiovascular and Interventional Radiological Society of Europe, and is also the official organ of a number of additional distinguished national and international interventional radiological societies. CVIR publishes double blinded peer-reviewed original research work including clinical and laboratory investigations, technical notes, case reports, works in progress, and letters to the editor, as well as review articles, pictorial essays, editorials, and special invited submissions in the field of vascular and interventional radiology. Beside the communication of the latest research results in this field, it is also the aim of CVIR to support continuous medical education. Articles that are accepted for publication are done so with the understanding that they, or their substantive contents, have not been and will not be submitted to any other publication.
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