Late-onset chylothorax following extrapleural pneumonectomy for mesothelioma

We report a 64-year-old woman treated with surgical intervention for late-onset chylothorax following a pleuropneumonectomy. The patient underwent an extrapleural pneumonectomy for diffuse malignant mesothelioma and was uneventfully discharged on postoperative day 29. Pleural effusion aspirated on postoperative day 9 was dark red. A chest roentgenogram taken at our outpatient clinic revealed a mediastinal shift on postoperative day 56. No bacterial infection was found in the milky effusion. We made a diagnosis of postoperative late-onset chylothorax based on the laboratory data obtained from tests of the pleural fluid. A repeat thoracotomy to ligate the lymphatic duct was performed because conservative management with chest tube drainage and no oral feeding was unsuccessful. The patient was discharged after the operation with a good clinical course.     

外伤性乳糜胸诊治体会

目的 探讨外伤性乳麋胸的诊断和治疗。方法 总结自1980年12月至2001年12月1385例胸外伤中发生乳麋胸者16例。其中左侧乳麋胸4例，右侧乳麋胸11例，双侧乳糜胸1例，采取保守治疗11例，胸导管结扎术5例。结果 死亡2例，余均治愈出院。结论 对外伤性乳麋胸应尽早作出诊断，采取合理的治疗手段，即可及时治愈，否则将造成病情的延误。     

食管癌切除术后乳糜胸的治疗及预防（附31例治疗分析）

我院自１９７５年～１９９４年食管癌切除术后发生乳糜胸３１例，早期发生率为１．９２％，保守治疗组及手术结扎胸导管治疗组病人的胸引流高峰期三天平均为４５０±２２０ｍｌ／天及９６０±２３０ｍｌ／天，二者有明显差别（Ｐ＜０．０１），认为胸引流量连续３～４天在８００～１０００ｍｌ／天以上又无下降趋势者，应及时手术治疗。自１９９１年以来，我们采取了综合预防措施，部分预防性结扎胸导管，其发生率明显下降为０．６％。     

A novel case of lymphangiomatosis in HIV

Diffuse lymphangiomatosis is a rare disorder characterized by abnormal proliferation of lymphatic channels. It can involve just one organ or multiple organs, such as liver, spleen, lungs, and bone. This disorder generally presents in children and young adults, but in rare cases, patients first present with symptoms in adulthood. Here, we describe a 48-year-old HIV-positive man who presented with shortness of breath. Computed tomography scan revealed a large right-sided pleural effusion and a heterogeneously enhancing liver. Thoracentesis demonstrated a chylous effusion and subsequent liver biopsy revealed a proliferation of dilated lymphatics to establish a diagnosis of lymphangiomatosis.     

短肽型肠内营养制剂治疗乳糜性胸水

目的:观察在乳糜性胸水病人早期应用短肽型肠内营养(EN)制剂对疾病转归的影响。方法:对17例确诊为乳糜性胸水的病人早期应用短肽型EN制剂作为保守治疗的主要措施。结果:15例病人经2周保守治疗后治愈,2例保守治疗无效经手术治疗后治愈。结论:早期应用短肽型EN制剂能改善乳糜性胸水保守治疗的疗效和改善病人的营养状态。     

胸外科手术后并发乳糜胸62例临床分析

目的探讨胸外科手术后并发乳糜胸的诊治方法。方法对986例肺癌患者术后并发乳糜胸17例（1．72％）和11669例食管癌患者术后并发乳糜胸45例（2．69％）资料作回顾性分析。结果肺癌组,开胸手术乳糜胸发生率1．34％,胸腔镜手术2．56％;食管癌组,开胸手术乳糜胸2．38％,胸腔镜手术4．24％。62例术后并发乳糜胸患者中,38例经保守治疗,37例治愈,1例死亡,手术24例均治愈,总治愈率为98．4％（61／62）。结论胸外科手术,特别是胸腔镜手术,应重视乳糜胸的发生;术后乳糜胸以手术治疗为主,对于乳糜胸引流量较少的患者,也可采用保守治疗。     

原发性乳糜性心包积液淋巴回流障碍的直接淋巴管造影和MSCT表现

目的 探讨直接淋巴管造影(DLG)和MSCT诊断乳糜性心包积液淋巴回流障碍的价值.方法 回顾性分析9例乳糜性心包积液的DLG及造影后MSCT资料;7例伴乳糜胸,其中1例伴乳糜痰;8例接受胸导管梗阻解除术.结果 9例DLG和MSCT均表现为胸导管出口梗阻;5例合并心包区反流,其中4例通过扩张的支气管纵隔干反流.8例接受胸导管出口梗阻解除术,术后病情好转.结论 DLG和MSCT可显示原发性乳糜性心包积液胸导管及属支异常,并能显示心包腔与淋巴系统的异常交通,后者可能是治疗的关键.     

食管癌贲门癌经胸切除术后严重并发症27例临床分析

目的：探讨食管癌、贲门癌经胸切除术后严重并发症发生的主要原因及其防治措施。方法：回顾分析1988年8月至2001年8月在我院经胸切除的食管癌、贲门癌784例患者，其中食管癌569例，贲门癌215例。结果：术后发生吻合口瘘17例，死亡4例，乳糜胸10例，死亡2例。结论：食管吻合技术的提高、吻合方法的改进和围手术期的处理，使食管癌、贲门癌经胸切除术后严重并发症的发生率明显降低。     

Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax

Background  Chylothorax after complex abdominal and thoracic procedures remains a challenging complication with a mortality rate reaching 50% if untreated [1]. Iatrogenic trauma accounts for almost 20% of all chyle leaks, and esophagectomy is the most common iatrogenic cause [2]. Consequences of ongoing chyle leak include dehydration, malnutrition, and immunocompromise. Methods  When nonoperative management techniques fail, prompt ligation of the thoracic duct at the diaphragmatic hiatus should be attempted. The authors present prone thoracoscopic thoracic duct ligation performed for two patients after laparoscopic transthoracic esophagectomy and revision paraesophageal hernia repair. Results  The prone position for thoracoscopic thoracic duct ligation offers several benefits to the surgeon. Gravity retracts the lung anteriorly, exposing the diaphragmatic hiatus. Single-lumen endotracheal intubation combined with low-pressure carbon dioxide insufflation efficiently collapses the lung to create ample working space. For the two reported patients, only three trocars were necessary to complete suture ligation of the thoracic duct via the right chest. Both patients had complete resolution of their chylothorax and recovered uneventfully. Based on this experience, the authors currently advocate early thoracoscopic treatment for cost and morbidity savings. Conclusions  The authors believe prone thoracoscopic thoracic duct ligation offers significant advantages to the patient in preventing the dangerous consequences of chyle leak in a timely, minimally invasive fashion. Importantly, the prone technique with carbon dioxide insufflation makes the technical challenges of thoracic duct ligation more facile for the surgeon. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.