術後リンパ漏に対するIVR治療

Interventional radiology for lymphatic leakage after surgery

リンパ管は全身に存在し，水分バランスの調整のみならず，免疫制御，代謝物の輸送などにおいて重要な役割を担っている。このため術後のリンパ漏は全身で起こり得る合併症であるが，部位によってリンパ液の漏出内容も異なり，重症度も多種多様である。一般には術後リンパ漏は保存的に改善し難治性リンパ漏となるのはまれであるとされている。しかし，いったん難治性になった術後リンパ漏は重篤になり得る病態である。特に難治性の乳び胸水は大量のリンパ液が胸腔に貯留し，呼吸機能に影響を与えるばかりでなく低栄養にもなるため早期の治療が推奨される。しかし漏出部位が同定できない場合や多量の場合は胸膜癒着術にも抵抗性で重篤になることが報告されてきた。

The lymphatic system is present throughout the body, and postoperative lymphatic leakage is a potential complication that usually improves conservatively and rarely results in refractory lymphatic leakage. As the lymphatic system plays an important role in the immune system, transport of metabolites, and fluid balance, postoperative refractory lymphatic leakage can be a serious condition. In particular, chylothorax, in which a large amount of lymph fluid accumulates in the thoracic cavity, has been reported to be refractory to pleurodesis and can be severe. Interventional radiology（IVR）is a relatively new treatment for lymphatic leakage and has been rapidly spreading throughout Japan in recent years. In particular, thoracic duct embolization for chylothorax has become the first treatment of choice in limited hospitals. However, IVR for lymphatic leakage varied remarkably and a systematic treatment strategy has not yet been established. The purpose of this article is to provide a systematic overview of the currently available IVR treatment strategies for postoperative lymphatic leakage. Additionally, various lymphangiography techniques that are essential for lymphatic IVR will also be mentioned.