Objective: To examine the clinical characteristics and abnormal reflux branches of primary isolated chylopericardium. Methods: Totally 43 patients with primary isolated chylopericardium at Department of Lymphatic Surgery, Affiliated Beijing Shijitan Hospital,Capital Medical University from June 2007 to January 2018 were recruited in this study. There were 21 males and 22 females, aging (23.0±15.9) years (range: 2 to 57 years). The levels of triglyceride, total cholesterol, total protein and albumin in pericardial effusion and blood were compared by paired-t test, and the characteristics of lymphatic system in direct lymphangiography and postoperative CT were analyzed. Results: Pericardial effusion was mainly milky white and monocytes, and 95.3%(41/43) were positive for Rivalta test. The level of triglyceride in pericardial effusion was significantly higher than that of blood ((9.67±5.11) mmol/L vs. (1.28±0.89) mmol/L, t=10.557, P<0.01), and the levels of total cholesterol ((2.19±0.52) mmol/L vs. (4.12±1.06) mmol/L, t=-3.732, P<0.01), total protein ((61.25±16.17) g/L vs. (68.26±8.30) g/L, t=-2.958, P=0.005) and albumin ((36.63±7.06) g/L vs. (42.32±4.73) g/L, t=-5.747, P<0.01) were significantly lower than that of blood. In the direct lymphangiography, the imaging of iliac and retroperitoneal lymphatics showed dilated or tortuous in 90.7% (39/43), the thoracoabdominal segment of thoracic duct showed dilation in 46.5% (20/43), and cervical thoracic duct imaging showed dilation in 44.2% (19/43) and stenosis in 55.8% (24/43). The image of lipiodol flowing into the vein showed obstruction at the venous angle. There were 60.5%(26/43) of the patients with lipiodol reflux through the bronchomediastinal trunk (type Ⅰ), 11.6%(5/43) with lipiodol diffusion to the pericardium through the abnormal pathway from the thoracic segment of the thoracic duct (type Ⅱ), while no communication pathway between the thoracic duct and the pericardial cavity (type Ⅲ) found in 27.9%(12/43). CT images obtained after the direct lymphangiography showed 34.9%(15/43) had abnormal distribution of lipiodol in pericardium, mediastinal lymph nodes and lung hilar lymph nodes, 46.5%(20/43) in mediastinal lymph nodes and lung hilar lymph nodes, 14.0%(6/43) only mediastinal lymph nodes, 4.6%(2/43) had no lipiodol in the above areas. Conclusions: Pericardial effusion compared with same period blood, has higher triglyceride, lower total cholesterol, total protein and albumin. The obstruction of the cervical segment of the thoracic duct and the formation of abnormal reflux branches would be corelative to primary isolated chylopericardium.
目的： 探讨原发孤立性乳糜性心包积液的临床特点及异常反流通路形成的原因。 方法： 回顾性分析2007年6月至2018年1月首都医科大学附属北京世纪坛医院淋巴外科收治的43例原发孤立性乳糜性心包积液患者的临床资料。男性21例，女性22例，年龄（23.0±15.9）岁（范围：2~57岁）。采用配对t检验比较心包积液和血液中甘油三酯、总胆固醇、总蛋白及白蛋白水平的差异，并分析直接淋巴管造影术及术后CT显示的淋巴系统结构特点。 结果： 原发孤立性乳糜性心包积液与血液相比，甘油三酯水平更高［（9.67±5.11）mmol/L比（1.28±0.89）mmol/L，t=10.557，P<0.01］，总胆固醇［（2.19±0.52）mmol/L比（4.12±1.06）mmol/L，t=-3.732，P<0.01］、总蛋白［（61.25±16.17）g/L比（68.26±8.30）g/L，t=-2.958，P=0.005］、白蛋白［（36.63±7.06）g/L比（42.32±4.73）g/L，t=-5.747，P<0.01］更低。直接淋巴管造影术显示，胸导管颈段表现为迂曲扩张型和紊乱纤细型，造影剂回流入血障碍，造影剂的异常反流通路包括经支气管纵隔干反流型26例、经胸导管胸段异常通路型5例、未见反流通路型12例。术后CT显示，41例心包、纵隔和肺门淋巴结不同程度造影剂显影，2例未见显影。 结论： 乳糜性心包积液与血液相比，表现为高甘油三酯、低总胆固醇、低总蛋白、低白蛋白。胸导管颈段结构异常造成乳糜回流障碍并形成异常反流通路可能与本病有关。.