已经超过20年的技术 Performed over the period of 20 years
最初是创伤性的 Initially for traumatic
后来是非创伤性的 Lately for non-traumatic
技术和经验随时间不断改善和拓宽Techniques and expertise improves overtime, so is the outcome

胸导管栓塞适应症

主要适应症是创伤性乳糜漏 Traumatic Chylous Leaks

包括
1. 乳糜胸
2. 乳糜盆腹水
3. 淋巴囊肿
4. ....

次要适应症非创伤性乳糜漏包括，

异常肺淋巴灌注 Abnormal Pulmonary Lymphatic Perfusion

   – 非创伤性淋巴漏 Non-traumatic chylothorax
   – 塑性支气管炎 Plastic Bronchitis
   – 间质性肺疾病 Interstitial Lung disease


正常肺淋巴引流	异常常肺淋巴引流

Non-traumatic chylothorax

非创伤性淋巴漏

经皮乳糜池穿刺，Seldinger法沿导丝置入微导管至胸导管内

乳糜胸影像：右前斜位碘油造影显示右侧淋巴管扩张迂曲并有双侧胸腔造影剂外溢，提示乳糜胸来源于淋巴管损伤

新生儿乳糜胸


Gray M., Kovatis KZ., Stuart T., et al. Treatment of congenital pulmonary lymphangiectasia using ethiodized oil lymphangiography. J Perinatol 2014;34(9):720–2.

–塑性支气管炎 Plastic Bronchitis


淋巴液经异常发育的淋巴管逆行灌注并经支气管漏出

支气管镜-胸导管注射美兰后....Broncoscopy-TD Injection With MB


支气管镜-胸导管注射美兰后....Broncoscopy-TD Injection With MB

– 间质性肺疾病 Interstitial Lung disease

间质性肺疾病 Interstitial Lung Disease

所谓异常淋巴灌注:Abnormal Pulmonary Lymphatic Perfusion

流向支气管树	塑性支气管炎
流向支气管树	Chylopthysis
流向间质	间质性肺疾病
流向胸膜腔	乳糜胸

如何治疗异常肺淋巴灌注How Do We Treat PLP? 主要是先经淋巴结穿刺造影，发现有异常淋巴灌注，行胸导管入路，包括经乳糜池穿刺，行胸导管导管术，最后胸导管栓塞。

胸导管入路 Thoracic Duct Access

胸导管入路技术 Thoracic Duct Access-Technique


through any organ...

胸导管注射 Lymphatic PB Thoracic Duct Injection

Itkin M, et al. Ann Am Thorac Soc. 2016;13(10):1689-96

胸导管胶栓塞 Glue Embolization

胸导管栓塞的结果 Outcome of the TDE

胸导管入路和淋巴造影的技术成功率 Technical success of lymphangiography and TD access

技术成功率 Technical Success

– 淋巴造影 LAG -94.2%

– 胸导管栓塞 TDE-63.1%

临床成功率 Clinical success

– 60.1%

尽管这一系统复习涵盖了淋巴造影技术的太长的历史，包括多家中心不同专家的不同经验，但也是最全面的总结

Kim PH., Tsauo J., Shin JH. Lymphatic Interventions for Chylothorax : A Systematic Review and Meta-Analysis Literature Selection and Characteristics. J Vasc Interv Radiol n.d.;29(2):194-202.e4.

并发症 Complication

围手术期并发症 Periprocedural Complications

胸导管栓塞严重并发症（2.4%）Major complication rate of TDE- 2.4%

- 胸导管入路并发症 TD access complications

感染 Infection
出血 Bleeding
器官损伤 Organ injury

- 误栓 Misembolization

- 失去入路 Access loss

- 乳糜池漏 Cisterna chyli leakage

- 乳糜胸水

Kim PH., Tsauo J., Shin JH. Lymphatic Interventions for Chylothorax : A Systematic Review and Meta-Analysis Literature Selection and Characteristics. J Vasc Interv Radiol n.d.;29(2):194-202.e4.

nBCA 肺栓塞 Complications-Glue PE


	肺胶栓塞 Pulmonary Glue Embolization

肺胶栓塞Pulmonary Glue Embolization

肺胶栓塞Pulmonary Glue Embolization

长期并发症 Long Term Complications

7/49（14%）有长期并发症 Total 7/49 (14%) had long term complications

腿肿 Leg swelling

– 4（8%）与经足背淋巴造影技术相关4 (8%)-related to pedal lymphangiography

– 经淋巴结淋巴造影没有发现 Not observed with intranodal lymphangiography

慢性腹泻 Chronic Diarrhea

- 3可能与倾倒综合征相关 3 (6%)-might be related to the dumping syndrome

Laslett D., Trerotola SO., Itkin M. Delayed complications following technically successful thoracic duct embolization. J Vasc Interv Radiol 2012;23(1):76–9.

胸导管栓塞是有效治疗乳糜胸水的方法TDE is effective treatment of chylothorax
栓塞前详细患者评估是基础 Thorough evaluation of the patient is essential before embolization
随经验胸导管栓塞的成功率得到改善 Success of the TDE improves with experience
一丝不苟的技术可以避免急性并发症发生 Acute complications can be avoided with meticulous technique（一丝不苟的技术）
胸导管栓塞长期并发症较少 Long term consequences of TDE is minimal

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