Basic study on thoracic duct-Inferior vena cava bypass operation for intractable chylothorax

• Project/Area Number: 17K16492
• Research Category: Grant-in-Aid for Young Scientists (B)
• Allocation Type: Multi-year Fund
• Research Field: Radiation science
• Research Institution: Kansai Medical University
• Principal Investigator: MARUYAMA Takuji 関西医科大学, 医学部, 助教 (20786678)
• Project Period (FY): 2017-04-01 – 2021-03-31
• Project Status: Completed (Fiscal Year 2020)
• Budget Amount: ¥3,770,000 (Direct Cost: ¥2,900,000、Indirect Cost: ¥870,000); Fiscal Year 2020: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2019: ¥1,170,000 (Direct Cost: ¥900,000、Indirect Cost: ¥270,000); Fiscal Year 2018: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2017: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
• Keywords: リンパ漏 / 胸管 / 乳び漏 / インターベンショナルラジオロジー（ＩＶＲ） / 放射線 / インターベンショナルラジオロジー（IVR）

Outline of Final Research Achievements

[Study]Measurement of the value of thoracic duct pressure before and after embolization of thoracic duct, and changes in the pressure gradient between the thoracic duct and the inferior vena cava(IVC) were researched. The thoracic duct of the swine was punctured under image guidance and a catheter was inserted. Another catheter was inserted into the IVC. Using these catheters the value of thoracic duct pressure were measured and the pressure gradient between the thoracic duct and the IVC was examined. The cervical part of thoracic duct was then embolized. After embolization the value of the thoracic duct pressure was measured again and the pressure gradient between the thoracic duct and the IVC was also examined.
[Results]We succeeded in image-guided thoracic duct puncture. We also succeeded in acquiring data on the value of thoracic duct pressure which is a less-reported. It was statistically shown that the thoracic duct pressure was significantly higher after embolization than before.

Academic Significance and Societal Importance of the Research Achievements

報告者らは胸管への画像ガイド下経皮経腹的アプローチ法を確立した。この手法は画像ガイド下に行うため低侵襲であり耐術能不良なリンパ漏の患者にも行える利点がある。また生体の胸管内に経皮経腹的にアプローチすることにより、生体における胸管内圧の実測値データの取得に成功した。生体の胸管内圧の報告は本邦初と思われる。そして胸管と下大静脈圧の圧較差データを取得した。さらに塞栓前後の胸管内圧の比較データを統計学的に解析すると、胸管塞栓後の胸管内圧が塞栓前の胸管内圧より有意に高いことが示された。これらの結果は難治性リンパ漏の病態解明及び難治性乳糜漏に対する新たな画像ガイド下治療法の開発につながる重要な知見である。