Bilateral Chylothorax Caused by Pleuropulmonary Lymphangiomyomatosis: A Challenging Problem in Thoracic Surgery

Massive left-sided pleural effusion in a 35-year-old man was initially diagnosed as idiopathic spontaneous chylothorax and treated with serial thoracenteses and left thoracotomy. Six weeks later, a right thoracotomy was performed for contralateral chylothorax, and histologic examination revealed lymphangiomyomatosis. The patient survived this rare and potentially fatal disease. We have found no previously published case of bilateral lymphangiomyomatosis treated with separate thoracotomies because of bilateral chylothorax.     

Intrapleural Bleomycin in the Treatment of Chylothorax

Summary

Chylothorax is an accumulation of thoracic lymph or chyle in the pleural cavity. It is a rare condition and is usually caused by trauma or malignant disease.

We present three cases with chylothorax due to malignant non-Hodgkin’s lymphoma [high grade malignant (1 case) and low grade malignant (2 cases)] treated with pleurodesis with bleomycin and systemic chemotherapy (CHOP, CNOP, trofosfamide). Complete remissions (CR) were achieved in all three cases. Two patients had a recurrent chylothorax 3 and 12 months after initial treatment. They were treated with a second intrapleural installation of bleomycin and continuing systemic chemotherapy (CNOP, trofosfamide) and are still alive in CR with a follow-up period of 28 and 30 months respectively. One patient died of relapsing non-Hodgkin's lymphoma after 23 months of follow-up. There was no sign of recurrent chylothorax.

We conclude that chylothorax caused by lymphoma can be satisfactorily controlled by pleurodesis with bleomycin combined with systemic chemotherapy. Immediate action is necessary to prevent great loss of lipids and proteins. The underlying malignancy must be controlled to achieve a good prognosis.     

14例新生儿先天性乳糜胸的护理

总结14例新生儿先天性乳糜胸的护理.护理要点包括:全胃肠外营养支持及喂养护理,保持胸腔闭式引流管的固定和通畅,胸腔内注射红霉素时监测生命体征,安抚哭闹患儿,预防感染和皮肤破损,加强疾病宣教.除1例家长要求自动出院外,其余13例均治愈.     

胸导管结扎在肺癌手术中应用的临床研究

目的探讨肺癌手术中行常规胸导管结扎的可行性及优越性。方法将80例肺癌手术患者随机分成研究组（胸导管结扎组）和对照组（不结扎胸导管）,两组均进行系统的淋巴结清扫。观察两组的术中术后情况及围手术期并发症发生情况,术前、术后1周分别进行血清载脂蛋白电泳,术前、术后2周、4周分别进行T细胞亚群测定,并进行统计学分析。结果两组比较,手术时间、失血量无显著性差异（P〉0．05）;术后乳糜胸的发生率无显著性差异（P〉0．05）;Ⅱ期、Ⅲa期患者胸腔引流量减少、带管时间及术后住院天数缩短（P〈0．05）;Ⅰ期患者两组术后胸腔引流量、带管时间、术后住院天数无显著性差异;两组手术前后血清载脂蛋白电泳以及手术前后T细胞亚群无显著性差异（P〉0．05）。结论肺癌手术中行胸导管结扎,不增加手术创伤,对术后肠道营养吸收及免疫功能的恢复没有影响,对于Ⅱ期Ⅲa期肺癌患者,行术中行胸导管结扎可以有效减少术后胸腔引流量,缩短术后住院时间。     

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.     

Lymphangiography: Forgotten Tool or Rising Star in the Diagnosis and Therapy of Postoperative Lymphatic Vessel Leakage

Since the advent of computed tomography, numbers and expertise in Lymphangiography (LAG) have markedly dropped. The intention of our study was to demonstrate the persisting diagnostic and therapeutic impact of LAG on the postoperative patient with known or suspected lymphatic vessel leakage. Between May 1, 1999, and April 30, 2006, we investigated pedal lipiodol-LAGs (18 monopedal, 2 bipedal) on 22 patients (16 male, 6 female) with known or suspected postoperative chylothorax, chylaskos, lymphocele, or lymphatic fistula. Ages varied from 26 to 81 years. The spectrum of operative procedures was broad: 6 thoracic, 5 abdominal, and 11 peripheral operations were performed. In 20 patients who underwent mono- or bipedal LAG for lymphatic vessel injury, we were able to demonstrate the specific site of leakage in 15 cases (75%) and found signs of extravasation in 5 patients (25%). Furthermore, in 11 patients (55%) we were able to avoid surgery because of closure of the leak after LAG. As the conservative therapeutic approach usually takes 2-3 weeks to reveal its therapeutic effects, 73.3% (11/15) of the patients who were not reoperated before this hallmark was passed did not need any further operation. Our study clearly demonstrates that even in the decades of modern cross-sectional imaging, classic LAG is a powerful and highly reliable tool to visualize and even assist occlusion of the postoperatively damaged lymphatic vessel and may thereby avoid the need for reoperation.     

电视胸腔镜辅助下肺癌根治术后乳糜胸的临床治疗方法及效果分析

目的 分析电视胸腔镜辅助下(video-assisted thoracoscopic surgery,VATS)肺癌根治术后乳糜胸的危险因素、治疗方法及临床效果.方法 连续性收集四川大学华西医院胸外科2012年1月至2020年1月期间诊断为乳糜胸400例患者的临床资料.根据纳入、排除标准,最终纳入VATS肺癌根治术后乳...     

直接淋巴管造影后MSCT诊断乳糜胸

目的探讨直接淋巴管造影(DLG)后MSCT诊断乳糜胸的价值。方法回顾性分析30例乳糜胸患者的DLG及DLG后MSCT成像资料,将MSCT与DLG影像相对照。结果 DLG后MSCT显示造影侧髂及腹膜后淋巴管扩张、纡曲30例(100%),与DLG相吻合;出现对侧髂腰部反流和腹膜后淋巴管扩张13例(43.33%),DLG显示9例(30.00%,P=0.13);出现腹腔反流4例(13.33%),DLG显示3例(10.00%,P=1.00);胸导管出口受阻20例(66.67%),DLG显示22例(73.33%,P=0.50);胸导管部分未显影9例(30.00%),DLG显示8例(26.67%,P=1.00);对比剂入血10例(33.33%),DLG显示4例(13.33%,P=0.07);对比剂漏出至胸腔8例(26.67%),DLG显示1例(3.33%,P=0.02)。两种检查均显示1例(3.33%)肺内淋巴管扩张(P=1.00)。结论 DLG后MSCT成像与DLG互为补充,可为乳糜胸的诊断及治疗提供重要依据。