Email Alert RSS
Volume 13 Issue 3
May  2022
Turn off MathJax
Article Contents
Abstract
References
AN Ran, XIA Song, SUN Yuguang, CHANG Kun, XIN Jianfeng, WANG Tingting, SHEN Wenbin. Clinical Characteristics of Patients with Primary Chylothorax Failed in Treatment of Thoracic Duct Ligation[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(3): 468-472. DOI: 10.12290/xhyxzz.2022-0148
Citation: AN Ran, XIA Song, SUN Yuguang, CHANG Kun, XIN Jianfeng, WANG Tingting, SHEN Wenbin. Clinical Characteristics of Patients with Primary Chylothorax Failed in Treatment of Thoracic Duct Ligation[J]. Medical Journal of Peking Union Medical College Hospital, 2022, 13(3): 468-472. DOI: 10.12290/xhyxzz.2022-0148
shu

Clinical Characteristics of Patients with Primary Chylothorax Failed in Treatment of Thoracic Duct Ligation

  • Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China

Funds: 

Beijing Municipal Science & Technology Commission Z191100007619049

More Information
  • Corresponding author:

    SHEN Wenbin, E-mail: shenwb@bjsjth.cn

  • Received Date: March 24, 2022
  • Accepted Date: April 21, 2022
  • Issue Publish Date: May 29, 2022
    Graphical Abstract
    • Abstract
  •   Objective  To summarize the clinical characteristics of patients with primary chylothorax who failed in the treatment of thoracic duct ligation (TDL).
      Methods  This study was a retrospective analysis. The subjects were patients with primary chylothorax who had failed in TDL treatment in other hospitals and were admitted to the Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from May 2007 to October 2021. The clinical features and results of direct lymphangiography (combined with CT imaging data after lymphangiography) after admission were summarized.
      Results  A total of 38 patients with primary chylothorax who met the inclusion and exclusion criteria were enrolled. After TDL treatment, 50.0%(19/38) patients had increased drainage of pleural effusion and 36.8% (14/38) patients developed new symptoms. The results of direct lymphangiography showed that the ligation of the thoracic duct was relatively complete in all patients. The patients generally had different degrees of lymphatic reflux disorder, and manifested lymphatic dilatation (94.7%, 36/38) and different forms of lymphatic reflux (92.1%, 35/38).
      Conclusions  In this study, the leaking point of primary chylothorax may be located between the cisterna chylior its branching lymphatic vessels and the ligation point. The failure of TDL treatment may be related to the aggravation of the existing lymphatic reflux disorder caused by TDL. Lymphangiography before TDL is recommended for patients with primary chylothorax to guide the formulation of treatment.
    • FullText(HTML)
    • References (16)
  • [1]
    Valentine VG, Raffin TA. The management of chylothorax[J]. Chest, 1992, 102: 586-591. DOI: 10.1378/chest.102.2.586
    [2]
    Schild HH, Strassburg CP, Welz A, et al. Treatment options in patients with chylothorax[J]. Dtsch Arztebl Int, 2013, 110: 819-826.
    [3]
    Soto-Martinez M, Massie J. Chylothorax: Diagnosis and Management in Children[J]. Paediatr Respir Rev, 2009, 10: 199-207. DOI: 10.1016/j.prrv.2009.06.008
    [4]
    Skouras V, Kalomenidis I. Chylothorax: diagnostic approach[J]. Curr Opin Pulm Med, 2010, 16: 387-393. DOI: 10.1097/MCP.0b013e328338dde2
    [5]
    Breaux JR, Marks C. Chylothorax causing reversible T-cell depletion[J]. J Trauma, 1988, 28: 705-707. DOI: 10.1097/00005373-198805000-00029
    [6]
    Kranzfelder M, Gertler R, Hapfelmeier A, et al. Chylo-thorax after esophagectomy for cancer: impact of the surgical approach and neoadjuvant treatment: systematic review and institutional analysis[J]. Surg Endosc, 2013, 27: 3530-3538. DOI: 10.1007/s00464-013-2991-7
    [7]
    Lampson RS. Traumatic chylothorax; a review of the literature and report of a case treated by mediastinal ligation of the thoracic duct[J]. J Thorac Surg, 1948, 17: 778-791. DOI: 10.1016/S0096-5588(20)31829-8
    [8]
    Cerfolio RJ, Allen MS, Deschamps C, et al. Postoperative chylothorax[J]. J Thorac Cardiovasc Surg, 1996, 112: 1361-1366. DOI: 10.1016/S0022-5223(96)70152-6
    [9]
    Shah RD, Luketich JD, Schuchert MJ, et al. Postesophagectomy Chylothorax: Incidence, Risk Factors, and Outcomes[J]. Ann Thorac Surg, 2012, 93: 897-904. DOI: 10.1016/j.athoracsur.2011.10.060
    [10]
    Sieczka EM, Harvey JC. Early thoracic duct ligation for postoperative chylothorax[J]. J Surg Oncol, 1996, 61: 56-60. DOI: 10.1002/(SICI)1096-9098(199601)61:1<56::AID-JSO12>3.0.CO;2-V
    [11]
    An R, Xia S, Sun Y, et al. New application of direct lymphangiography in the diagnosis and treatment of chylothorax after lung cancer surgery: a case series[J]. Ann Palliat Med, 2021, 10: 4768-4776. DOI: 10.21037/apm-21-263
    [12]
    Nadolski GJ, Itkin M. Lymphangiography and thoracic duct embolization following unsuccessful thoracic duct ligation: Imaging findings and outcomes[J]. J Thorac Cardiovasc Surg, 2018, 156: 838-843. DOI: 10.1016/j.jtcvs.2018.02.109
    [13]
    Lee FC. Changes in the number of small lymphocytes of the blood following ligation of the thoracic duct[J]. J Exp Med, 1922, 36: 247-260. DOI: 10.1084/jem.36.2.247
    [14]
    Dickerson VM, Grimes JA, Secrest SA, et al. Abdominal lymphatic drainage after thoracic duct ligation and cisterna chyli ablation in clinically normal cats[J]. Am J Vet Res, 2019, 80: 885-890. DOI: 10.2460/ajvr.80.9.885
    [15]
    Melduni RM, Oh JK, Bunch TJ, et al. Reconstruction of occluded thoracic duct for treatment of chylopericardium: a novel surgical therapy[J]. J Vasc Surg, 2008, 4: 1600-1602.
    [16]
    Chick JFB, Hage AN, Patel N, et al. Chylothorax secondary to venous outflow obstruction treated with transcervical retrograde thoracic duct cannulation with embolization and venous reconstruction[J]. J Vasc Surg Cases Innov Tech, 2018, 4: 193-196. DOI: 10.1016/j.jvscit.2018.03.010
    • Related Articles

Catalog

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (830) PDF downloads (65) Cited by()
    Related
    Links: National Health Commission of the People's Republic of China Chinese Academy of Medical Sciences(CAMS) AMLC Check CNKI Database CNKI Term Online Chinese General Practice
    Address：Room 302,Third Floor,Building 7, No. 1 Shuaifuyuan, Wangfujing, Dongcheng District, Beijing 100730, China
    Tel：010-69154261/4262
    E - mail：medj@pumch.cn mjpumch@126.com
    Copyright of website：Editorial Office of Medical Journal of Peking Union Medical College Hospital

    Supported by: Beijing Renhe Information Technology Co., Ltd.  Baidu Analytics

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return
    x Close Forever Close