乳糜盆/腹水：治疗性淋巴造影技术

碘油淋巴造影

Oil-based lymphangiography

淋巴管渗漏是一种严重的并发症，在外科手术导致后胸膜腔渗出或腹部乳糜腹水取决于损伤部位和手术方式，这种并发症可能发生在多达2.5%[1]。

1. Miao L, Chen H, Xiang J, Zhang Y. Journal of Cancer Research and Clinical Oncology. 2015;141:941–950

保守治疗，包括饮食和不同的药物(例如。奥曲肽)可能是无效的33-25%的这些患者【1-4】，特别是在高输出淋巴漏。

1. Milonakis M, Chatzis AC, Giannopoulos NM, Contrafouris C, Bobos D, Kirvassilis GV, Sarris GE. Journal of cardiac surgery. 2009;24:369–373

2. Lorenz K, Abuazab M, Sekulla C, Nguyen-Thanh P, Brauckhoff M, Dralle H. Langenbeck's archives of surgery/Deutsche Gesellschaft fur Chirurgie. 2010;395:911–917

3. Leibovitch I, Mor Y, Golomb J, Ramon J. The Journal of urology. 2002;167:449–457

4. Evans JG, Spiess PE, Kamat AM, Wood CG, Hernandez M, Pettaway CA, Dinney CPN, Pisters LL. Journal of Urology. 2006;176:1463–1467

包括胸导管栓塞术(TDE)在内的INL提供了一种微创的治疗方案

实施淋巴介入寻求保守及外科治疗以外更为安全有效的方法。首先需要淋巴造影

超声引导下22G针穿刺淋巴结门，注意皮下长路，以稳定位置。


仔细缓慢注射造影剂，识别淋巴管其典型的纤细和蜿蜒外观，以证明淋巴结内针的位置	在针头脱位或淋巴管破裂的情况下，最好在两侧穿刺淋巴结

自从经腹股沟淋巴结注射淋巴造影问世后，由于技术简单，实施病例不断增加Increasingly performed after introduction of inguinal intranodal lymphangiography

淋巴漏发现率64-86%Leakage detection rate: 64 – 86%
碘油淋巴造影技术有治疗价值 Therapeutic value of oil lymphangiography for leaks
治疗性淋巴造影 theraputic lymphangiography

机制（假设）Mechanism (hypothesis):
- 通过逸出的碘油的炎性反应 Inflammatory reaction by extravasated oil?

- 油珠的栓塞效应 Embolic effect of oil droplets?
Cárdenas A. Am J Gastroenterol. 2002;97:1896–1900

经淋巴结造影的优势

淋巴造影剂上升速度＞足背入路 Inguinal (or cervical) nodal > pedal access

碘油加热降低液体的粘滞性 Pre-warming of oil to lower viscosity of fluid

追赶淋巴结减少时间和剂量Chasing nodes to reduce time and dose

应用栓塞前磁共振淋巴造影Utilize MR lymphangiography prior to embolization

栓塞或不栓塞 Whether to embolize or not?

选择淋巴入路 Choice of access?
追逐淋巴结显影 Chasing lymph nodes

减少时间和剂量 Reduced time and dose

治疗性淋巴造影
- 成功率 56-86%
- 需要更多的明确的治疗？ Need for more definite treatment?
  
  Matsumoto et al. BJR 2009, Kawasaki et al. AJR 2013
  
  栓塞 Embolization
  
  很多胸导管栓塞文献报告基于Cope（1999年）报告之后Numerous publications on TDE after first report by Cope et al (1999)
  
  胸导管以下栓塞较少报告Less publications on embolization below the TD
  
  Guermazi et al. Radiographics. 2003;23(6):1541-58
  Witte CL et al. Radiographics. 2000;20(6):1697-719.


术后2个月，CT 冠状MIP显示左侧淋巴漏	一线治疗是经皮穿刺引流和硬化治疗，但未能成功，所以行超声引导下，25G脊髓穿刺针经淋巴结穿刺淋巴造影。为了减少穿刺针的移动，淋巴结穿刺前先行连接管接入。 Initial spot image of the pelvis/inguinal region demonstrating needle access of small lymph node and opacification of proximal lymphatic vessels.

针尖在淋巴结皮质和淋巴结门移行区，在透视监视下注射碘油

A total volume of 10 mL of lipiodol is injected using an injection pump is used at the njection rate of 0.2mL/minute. Serial fluoroscopic spot images are obtained.

Follow-up spot images of lower abdomen demonstrating upward flow of lymphatics and evidence of lymphatic leak showing in the left pelvic lymph node dissection region with pooling of Lipiodol contrast。

淋巴渗漏是一种罕见但严重的并发症，可发生在各种手术后。大多数术后淋巴管渗漏是小的和自我愈合。

另一方面，淋巴漏并发症，如感染和压迫邻近的结构。可见输尿管压迫引起的肾积水，静脉压迫引起的下肢水肿和血栓形成，神经压迫引起的腿部/背部疼痛。

There are several treatment modalities for lymphatic

有N多的方法治疗淋巴漏，包括抽吸、影像引导下经皮置管引流和硬化或不硬化治疗。经淋巴结淋巴造影是顽固性淋巴漏有价值的选择。其中包括治疗性淋巴造影

The mechanism for lymphangiographywhich reduces lymphatic leaks has not yet been fully clarified. Some authors have suggested that lipiodol undergoes an inflammatory reaction during its extravasation.

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乳糜盆/腹水：治疗性淋巴造影技术

碘油淋巴造影