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

  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.