目的:探讨淋巴结内淋巴管造影(INL)和淋巴栓塞(LE)治疗肿瘤术后乳糜腹水的安全性和有效性。
方法:回顾性回顾2017年1月至2022年6月接受INL伴或不伴LE患者的记录。纳入了在保守治疗失败后进行介入放射学的肿瘤外科手术后出现乳糜性腹水的成年患者。纳入了39例接受55次手术的患者(男性34例,女性5例)。患者人口统计数据,程序技术,结果,并收集了后续行动。描述性统计数据被用来说明技术成功,临床成功,和不良事件。进行单因素logistic回归分析以评估预测临床成功的因素。
结果:INL在55例手术中的54例(98%;95%置信区间[CI],90%-100%)。在40个手术中发现了淋巴渗漏,LE在36年尝试。在36例手术中,LE技术上是成功的33例(92%;95%CI,78%-98%)。临床成功,定义为不需要腹膜静脉分流术或额外手术的腹水消退,39例患者中有22例(56%;95%CI,40%-72%)。1次手术后,18例患者获得了临床成功,需要重复手术的患者获得临床成功的可能性较小(比值比,0.16;95%CI,0.04-0.66;P=0.012)。记录了四个1级手术不良事件。
结论:INL伴或不伴LE是一种安全的微创工具,可以帮助保守治疗失败的肿瘤手术后乳糜腹水患者避免更多的侵入性干预。
OBJECTIVE: To investigate the safety and effectiveness of intranodal lymphangiography (INL) and lymphatic embolization (LE) in management of chylous ascites after oncologic surgery.
METHODS: Retrospective review of records of patients who underwent INL with or without LE from January 2017 to June 2022 was performed. Adult patients with chylous ascites after oncologic surgery referred to interventional radiology after failure of conservative treatment were included. Thirty-nine patients who underwent 55 procedures were included (34 males and 5 females). Data on patient demographics, procedural technique, outcomes, and follow-up were collected. Descriptive statistics were used to illustrate technical success, clinical success, and adverse events. Univariate logistic regression analysis was performed to evaluate factors predicting clinical success.
RESULTS: INL was technically successful in 54 of 55 procedures (98%; 95% confidence interval [CI], 90%-100%). A lymphatic leak was identified in 40 procedures, and LE was attempted in 36. LE was technically successful in 33 of the 36 procedures (92%; 95% CI, 78%-98%). Clinical success, defined as resolution of ascites with no need for peritoneovenous shunt placement or additional surgery, was achieved in 22 of 39 patients (56%; 95% CI, 40%-72%). Clinical success was achieved in 18 patients after 1 procedure, and patients who required repeat procedures were less likely to achieve clinical success (odds ratio, 0.16; 95% CI, 0.04-0.66; P = .012). Four grade 1 procedural adverse events were recorded.
CONCLUSIONS: INL with or without LE is a safe minimally invasive tool that can help patients with chylous ascites after oncologic surgery who failed conservative treatment avoid more invasive interventions.