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Objective:To evaluate the feasibility, safety, treatment outcome, and the individualized surgical procedure selection of the interventional treatments of chylous leakage.Methods:From July 2019 to January 2022, the clinical data of 60 consecutive patients with chylous leakage underwent interventional treatment were respectively analyzed. The cases included chylothorax ( n=37), chylous ascites ( n=10), chyluria ( n=4), chylothorax combined with chylous ascites ( n=5), chylothorax combined with chylopericardium ( n=2), and pelvic chylous effusion ( n=2). Conservative treatment was considered to have failed for all patients. The lymphangiography was firstly performed to detect chylous leakage, then an individualized procedure was selected according to the lymphangiography results. The treatment outcomes and complications were recorded, and follow-up was performed. Results:Lymphangiography was technically successful in 55 of 60 patients (91.7%), and no cisterna chyli and thoracic duct opacification was observed in 5 patients. The procedures for the patients included lymphangiography alone ( n=23), thoracic duct embolization ( n=23), thoracic duct disruption ( n=5), lymphatic embolization for pelvic chylous effusion ( n=4), and balloon plasty for thoracic duct ( n=5). Clinical success was achieved in 53 of 60 cases (88.3%). The complication rate was 8.3% (5/60), and all complications were minor. The median follow-up time was 11 months (range 0.5-30 months) for 56 patients, and 4 patients were lost to follow-up. There was one patient presenting the reoccurrence of symptom, and 8 patients died. Conclusions:The interventional treatment of chylous leakage is safe with good outcomes and low complication rate. Individualized treatment procedures based on the lymphangiography findings is feasible and with good curative effect.
ABSTRACT
Chyluria is characterized by the presence of chyle in the urine. The most common cause of non-parasitic chyluria is the upstream obstruction of the thoracic duct and reflux of the chyle into the renal collecting system. Traditional treatments include dietary modifications and surgery. The recently developed new interventional technique to treat chyluria. Here, we firstly reported one case of chyluria caused by thoracic duct obstruction in China, which was successful treated with intranodal lymphangiography combined by percutaneous balloon plasty. The symptoms of chyluria were completely relieved after our operation, which provides a minimally invasive, safe and effective method for patients with ineffective chyluria after conservative treatment or surgery.
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Objective To evaluate the safety and efficacy of 125I seed strands cavity brachytherapy for ureteral carcinoma.Methods To tally 10 patients with ureteral carcinoma underwent Carm CT and DSA guided percutaneous nephrostomy with 125I seed strands cavity brachytherapy.The technical success rate,complications,tumor local control rate,ureteral patency andsurvival time,and compared the Karnofsky scores,Girignon grade,pain score before and after treatment were evaluated.The dose related parameters were compared between pre-and post-treatment.Results 125I seed strands implantation was successfully completed in all patients with technical success rate of 100％.The mean procedure time was (12.3 ±3.8) min.No severe complications such as ureteral perforation,infection,severe bleeding occurred.Local tumor response was CR in 4 cases and PR in 6 cases,showing local control efficiency (CR + PR) 100％ after 2-3 months.Ureteral patency rate was 50％ (5/10).Postprocedure Karnofsky scores,Girignon grades,and pain scores were significantly improved (Z =-2.72,-2.88,-2.83,P＜0.01).The average follow-up time was (14.6 ±6.5) months (5-25 months),tumor progression was observed in 3 cases,stable disease in 7 cases.Nine cases were alive and one died due to multiple organ failure.The differences of D90％,mPD,V100％,V150％,V200％,CI,EI,HI between the preand post-treatment were not statistically significant (P ＞ 0.05).Conclusions 125I seed strands cavity brachytherapy for ureteral carcinoma is an effective and safe procedure without serious complications,and an effective alternative treatment for patients who are unable to undergoor refuse surgery.
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Objective To evaluate the therapeutic efficacy of agitating thrombolysis technique for Budd-Chiari syndrome complicated with inferior vena cava (IVC) fresh thrombus. Methods From August 2004 to March 2009, 5 patients of Budd-Chiari syndrome (four males and one female, aged 36-48 years) with IVC fresh thrombus were treated with agitating thrombolysis technique. After anpography of IVC the recanalization of IVC was performed, which was followed by agitating thrombolytic therapy. Finally,IVC was dilated with percutaneous transluminal balloon angioplasty. Clinical follow-up of IVC patency was conducted by color Doppler sonography. Results After agitating thrombolysis. The thrombi were completely disappeared in all 5 patients without single occurrence of pulmonary embolism. In all patients, IVC remained patency on color Doppler ultrasonograph after following up for a mean period of 23.8 months. Conclusion Agitating thrombolysis technique is a safe and effective treatment for Budd-Chiari syndrome complicated with IVC fresh thrombus.