PDF(Pubmed)
Abstract：
UNASSIGNED: Chylous ascites resulting from postoperative lymphatic leaks are uncommon but difficult to treat in cases with unsuccessful conservative treatment.
UNASSIGNED: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson-Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage.
UNASSIGNED: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.
UNASSIGNED: We report the case of an 80-year-old woman who had previously undergone multiple procedures for peritoneal dissemination 3.5 months after a laparoscopic bilateral salpingo-oophorectomy for ovarian cancer. After hospital discharge, she gradually gained weight, and examination findings indicated lymphatic leakage. We performed drainage using an 8.5-French Dawson-Mueller catheter, but more aggressive treatment was deemed necessary. We determined that it would be difficult to fill the large space, in which the leaking lymph fluid was accumulating, with embolic materials. Therefore, we performed superselective embolization of these inflowing lymphatic vessels to allow control of the chylous ascites. To overcome the technical difficulty associated with the insertion of a microcatheter from a large leakage cavity into a small inflow lymphatic vessel, we adopted a triple coaxial system that utilizes a steerable microcatheter. Successful embolization resulted in marked decrease in drainage. Follow-up computed tomography revealed no evidence of reaccumulation of chylous ascites. A three-month follow-up revealed no recurrence of lymphatic leakage.
UNASSIGNED: To our knowledge, this is the first report on the treatment of large retropenitoneal chylous leakage by superselective embolization of the inflowing lymphatic vessels using steerable microcatheters. This method allows large lymphatic leaks to be treated with only a small amount of N-butyl 2-cyanoacrylate mixture and without the use of coils, and we firmly believe that it should be considered for the treatment of large refractory chylous ascites.
摘要：
■术后淋巴漏引起的乳糜腹水并不常见，但在保守治疗不成功的情况下难以治疗。
我们报告了一例80岁女性，该女性在腹腔镜双侧输卵管卵巢切除术后3.5个月曾接受多次腹膜播散手术。出院后,她的体重逐渐增加,检查结果显示淋巴渗漏。我们使用8.5-FrenchDawson-Mueller导管进行引流,但更积极的治疗被认为是必要的。我们确定很难填满这个大空间，漏出的淋巴液在积聚，用栓塞材料。因此,我们对这些流入的淋巴管进行了超选择性栓塞，以控制乳糜腹水。为了克服与将微导管从大的泄漏腔插入到小的流入淋巴管中相关的技术难题，我们采用了三同轴系统，利用可操纵的微导管。成功的栓塞导致引流明显减少。后续计算机断层扫描显示没有乳糜腹水再积聚的证据。三个月的随访显示淋巴漏没有复发。
■据我们所知，这是关于使用可操纵的微导管超选择性栓塞流入的淋巴管治疗大的腹膜后乳糜渗漏的首次报道。这种方法允许仅用少量的2-氰基丙烯酸正丁酯混合物处理大的淋巴渗漏，而不使用线圈，我们坚信它应该被考虑用于治疗大量难治性乳糜性腹水。
我们报告了一例80岁女性，该女性在腹腔镜双侧输卵管卵巢切除术后3.5个月曾接受多次腹膜播散手术。出院后,她的体重逐渐增加,检查结果显示淋巴渗漏。我们使用8.5-FrenchDawson-Mueller导管进行引流,但更积极的治疗被认为是必要的。我们确定很难填满这个大空间，漏出的淋巴液在积聚，用栓塞材料。因此,我们对这些流入的淋巴管进行了超选择性栓塞，以控制乳糜腹水。为了克服与将微导管从大的泄漏腔插入到小的流入淋巴管中相关的技术难题，我们采用了三同轴系统，利用可操纵的微导管。成功的栓塞导致引流明显减少。后续计算机断层扫描显示没有乳糜腹水再积聚的证据。三个月的随访显示淋巴漏没有复发。
■据我们所知，这是关于使用可操纵的微导管超选择性栓塞流入的淋巴管治疗大的腹膜后乳糜渗漏的首次报道。这种方法允许仅用少量的2-氰基丙烯酸正丁酯混合物处理大的淋巴渗漏，而不使用线圈，我们坚信它应该被考虑用于治疗大量难治性乳糜性腹水。
