Human sorrow and joy are not connected
That's probably
27-year-old Ningbo Xiangshan boy Ah Hui (pseudonym)
Common perceptions
At one point, he hovered on the brink of life and death
It was like a Tang monk drinking the water of his daughter's country
Ah Hui's abdomen bulged as if she were pregnant
He was pale, emaciated, and had difficulty moving
At least 2 pounds of "milk" is drawn from the abdomen every day
The First Affiliated Hospital of Zhejiang University School of Medicine
Interventional radiology experts have found that they have peeled back the cocoon
It turned out to be a lymphatic fistula
The almost transparent lymphatic vessels are as thick as a hair
How do I close a gap?
"Zhejiang Yiren" has never lacked the courage to challenge difficult cases
Lead the province to carry out
Trans-lymph node iodine oil lymphangiography
Minimally invasive treatment of refractory lymphangial fistula
Today, the technology is benefiting more and more patients
01
The young boy's stomach flows out of the "milk"
2 years have passed, in addition to regularly coming to the First Hospital of Zhejiang University for follow-up, there is not much difference between the 27-year-old young man Ah Hui and the healthy person. But that winter of 2019, he was tormented by illness and died.
It turned out that the young Ah Hui was diagnosed with chronic kidney disease, and with the continuous progress and deterioration of the condition, he underwent kidney transplant surgery in a hospital in another province in 2019. Shortly after the operation, Ah Hui began to experience pain in the lower abdomen, draining at least 500-1000 ml of milky white liquid from his abdominal drainage tube every day.
After a series of conservative treatments such as fasting, Ah Hui's condition did not improve, he was seriously anemic, his belly was swollen, and he was miserable, after many inquiries, his family took Ah Hui to the Kidney Disease Center of the First Hospital of Zhejiang University for further treatment.
The milky white liquid flowing from the drainage tube inserted in Ah Hui's stomach has attracted the attention of experts, and the experts of the Kidney Disease Center invited the radiological intervention team of the First Hospital of Zhejiang University led by Chief Physician Peng Zhiyi to consult with Ah Hui. After a detailed understanding and analysis of Ah Hui's condition, experts believe that the chyloid ascites is leaked and ruptured by lymphatic vessels, causing chyle to leak into the abdominal cavity.
The lymphatic system of the human body, like the blood circulation system, spreads throughout the body, resisting foreign bacteria, viruses, and decomposing, digesting and absorbing metabolites in the body. The lymph fluid is normally pale yellow, while the lymph of the intestine is derived from the macromolecular fats and proteins produced after absorbing nutrients from food, and has a milky appearance, called chyle.
The lymphatic system of the human body
"After normal people eat, food is digested and decomposed through the digestive tract, and absorbed through the small intestine into chylodrome nutrients into the lymphatic system and then into the blood circulation, providing energy for the body. Lymphatic vessel injury can cause chyloide fluid leakage and pelvic effusion, causing bloating or compression. Ying Shihong, deputy chief physician of the Radiology Department who participated in the consultation, analyzed the causes of Ah Hui's "chyle", and the most common causes of chyloidal ascites have always been abdominal malignancy and cirrhosis, accounting for about 2/3 of all cases, followed by tuberculosis and filariasis, and other causes include congenital diseases, inflammatory diseases, surgical and traumatic diseases.
Ah Hui is most likely because of this small-probability complication after surgery - lymphatic fistula (lymphatic fistula), which ruptured the lymphatic vessels due to iatrogenic injury, causing the lymphatic fluid to overflow. The continuous loss of lymph fluid will not only lead to electrolyte abnormalities, hypoproteinemia, decreased immune function, etc., but also serious and even life-threatening.
02
Minimally invasive interventional methods for the treatment of refractory lymphatic fistula
Persistent, "high-flow" lymphatic fistula has long been one of the problems that plague clinicians. The traditional treatment method is surgery, but the trauma is large and time-consuming, and the hair-thin, almost transparent lymphatic vessels during the operation are difficult to find small leakage points, and the success rate of surgery is low.
Deputy Chief Physician Ying Shihong of the Department of Radiology formulated a strict surgical plan and diagnosis and treatment plan for Ah Hui - puncture of inguinal lymph nodes under ultrasound guidance, and then contrast and embolization with iodized oil.
Ying Shihong Deputy Chief Physician In the ultrasound medicine department director Jiang Tianan chief physician, Zhao Qiyu deputy chief physician and other experts help and close cooperation, Ah Hui's bilateral inguinal lymph nodes were successfully punctured, connected to the syringe slowly injected super liquefied iodine oil to develop the lymphatic vessels, through every interval of 3-5 minutes of photography, about 1 hour or so lymphatic vessel rupture is fully displayed, due to the role of iodized oil and partial embolism, even if the operation is successfully completed, follow-up combined with dietary control, etc., the fistula will slowly close.
There is no needle in the eye, but there is a needle in the heart. One move and one style, it seems ordinary, but in fact, it has deep internal skills. To Ah Hui's surprise, there was no special pain throughout the operation, but the treatment effect was immediate. The day after the operation, the "milk" drained from his abdominal cavity was significantly reduced, and the color changed from the original milky white to yellowish; a few days later, the CT results showed that the abdominal pelvic effusion completely disappeared; half a month after the operation, the drainage tube accompanied by Ah Hui for nearly 3 months was removed, and he has since returned to normal life.
In fact, the anatomy of the lymphatic system is very complex, the variation is large, the interventional technology is very delicate and difficult to master, and only a few top hospitals in China can successfully carry out it.
Since 2019, the Department of Radiology of the First Hospital of Zhejiang University has taken the lead in the province, innovatively carried out lymphatic fistula interventional treatment, and through this newly developed minimally invasive technology in the world, transdividated lymphophoretic imaging and embolization of patients' lymphatic fistula, and if necessary, it can be supplemented by spring coil or tissue glue embolism therapy, so as to obtain the exact effect with minimal trauma, so that many patients benefit.
03
Don't underestimate this leak, it is life-threatening
At present, minimally invasive interventional methods for the treatment of refractory lymphatic fistula are the leading international minimally invasive technologies, and only a few top-level hospitals can carry out them. Interventional lymphangiography and embolization have the advantages of simple, invasive and low cost, which are not only effective diagnostic methods, but also can be used to treat postoperative lymphatic fistula. There are literature reports that lymphangiography is effective up to 89%, and in the future, it is expected to become a first-line choice for patients who do not respond to conservative treatment of lymphatic fistula.
According to experts, the causes of lymphatic fistula include malignant tumors, congenital lymphangiopathy, trauma, infection and many other factors, and the incidence of lymphangial fistula in different parts is different, so there is no exact incidence and incidence trend data for the disease as a whole.
Depending on the location of lymphangial fistula, the clinical manifestations are different: some are manifested by a wound or postoperative drainage tube with a clear yellowish liquid and swelling of the affected limb; some are manifested as chylothorax, chyloid abdomen, chyle urine, and there will also be wheezing, chest tightness, abdominal bulging, and urinary pain. Persistent lymphangial fistula can lead to increasing symptoms, malnutrition, susceptibility to infection, and even life-threatening loss of nutrient-rich lymph fluid.
Expert outpatient table of the First Hospital of Zhejiang University