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膈肌是有孔的
同时发生的乳糜腹水和乳糜胸水
In case of simultaneous chylous ascites and chylothorax
– 来源于腹部 Source is in the abdomen
– 乳糜胸水是继发的 Chylothorax is secondary
由于胸部负压导致Negative chest pressure
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Chylous Ascites Presented as Chylothorax
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乳糜腹水胸导管栓塞会使腹水（和胸水）恶化 Embolization of the thoracic duct in chylous ascites, will make ascites (and chylothorax) worse
请检查所有非创伤乳糜胸水是否来自乳糜腹水 Please check all non traumatic chylothorax for chylous ascites!!
乳糜胸水-腹膜后来源 Chylothorax - Retroperitoneal Flow
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Itkin M, Et al Diagnosis and Treatment of Non-Traumatic Chylothorax Using Advanced Lymphatic Imaging and Percutaneous Lymphatic Embolization, American Journal of Respiratory and Critical Care Medicine 2017;195:A1547
腹膜后灌注 Retroperitoneal Perfusion
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乳糜胸水 腹膜后来源 Chylothorax - Retroperitoneal Flow
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- 非创伤性淋巴漏 Non-Traumatic Chylothorax 也是误诊淋巴来源的一个因素
系统回顾所用文献比较旧
Including in the systematic review older studies
乳糜胸的定义仍然是个迷 Definition of Chylothorax-Still Enigma
乳糜来自膈以下小肠淋巴
Chyle is generated in intestinal lymphatics below diaphragm
但有些患者病人常合并其它疾病 Often patient present with concomitant diseases
– 心功能衰竭 Heart failure
– 淋巴瘤 Lymphoma
– 肺炎 Pneumonia
外科失败后胸导管栓塞的结果 Outcome-TDE After Failed Surgery
50 patients post unsuccessful TDE/TDD
39例为创伤性患者 Traumatic 39 patients (78%)
淋巴漏解决45例患者 Resolution of the leak in 45 patients (90%)
显著减少漏出的2例患者 Significant reduction of output in 2 patients
3例患者初次栓塞后乳糜胸持续 3 patient chylothorax persisted (first embolization cases)
Nadolski GJ., Itkin M. Lymphangiography and thoracic duct embolization following unsuccessful thoracic duct ligation: Imaging findings and outcomes. The Journal of Thoracic and Cardiovascular Surgery 2018