Blood patch treatment of chylothorax following transthoracic oesophagogastrectomy: a novel technique to aid surgical management

Chylothorax is a well-recognised complication of oesophagectomy, occurring in around 3% of cases. If managed conservatively, the mortality rate can be over 50%. We describe our experience of managing a patient with a chylothorax following oesophagectomy, and the use of a blood patch (a novel technique) to overcome persistent leakage following re-operation. The authors feel that this technique has the potential for a wider application in the treatment of chyle leak, especially if combined with minimally invasive or radiological techniques.     

Congenital pleural effusions: 15 years single-centre experience from North-East England

Aim: The aim of this study is to add to the scant literature on congenital pleural effusions to aid counselling and clinical management decisions.

Methods: Retrospective case series of 15?years of congenital pleural effusions resulting in live birth in a single tertiary foetal medicine/neonatal centre in North East England.

Results: Data were available for 21 infants. Mortality rates were 43% overall. All spontaneous resolution occurred within 9?d, and active management was used where effusions persisted beyond this.

Conclusion: Prematurity was associated with a poor prognosis. Resolution without active management occurred before day 10 and active strategies should be considered by this time.     

Postoperative Chylothorax Development Is Associated with Increased Incidence and Risk Profile for Central Venous Thromboses

This study tested the hypothesis that pediatric patients who develop chylothorax (CTX) after surgery for congenital heart disease (CHD) have an elevated incidence and risk profile for central venous thrombosis (CVT). We evaluated 30 patients who developed CTX after surgery for CHD. All but one CTX patient were surgery-, anatomy-, and age-matched with two controls (NON-CTX) to compare their relative risk and incidence of CVT. Using conditional logistic regression analyses, CTX development was associated with significantly longer ventilator dependence (14.8 ± 10.9 vs. 6.1 ± 5.9 days, p = 0.003) and a non-significant trend towards more days of central venous catheters (CVC) (19.1 ± 16.6 vs. 12.2 ± 10.0 days; p = 0.16) when comparing the period prior to CTX development with the entire hospitalization in NON-CTX patients. CTX development was associated with a significantly elevated mortality risk (Odds Ratio 6.2, 95% CI 1.3–30.9). Minimum and mean daily central venous pressures were significantly higher in the CTX group. Post operative need for extracorporeal membrane oxygenation conferred an increased risk of CTX development in this sample of patients (Odds Ratio 9.9, 95% CI 2.2–44.8). Incidence of documented CVT was 26.7% in the CTX group versus 5.1% in the NON-CTX group. Prospective screening for CVT risk and formation, combined with early removal of CVC may help reduce the incidence of CTX.     

食管癌贲门癌术后乳糜胸的处理

目的　探讨食管瘤贲门癌切除术后并发乳糜胸的处理方法。方法　本组13例病人中8例行外科手术治疗，术前2小时给予患者500ml牛奶和100～2009动物油口服，通常选择乳糜胸侧开胸切口，双侧乳糜胸则经右侧入路。结果　8例手术者6例痊愈，5例行保守治疗的病人中3例死亡。结论　食管癌贲门癌术后乳糜胸应以外科手术为首选治疗方法，保守治疗只能选择性地应用。     

奥曲肽在婴幼儿心胸手术后乳糜胸治疗中的临床应用

目的 探讨奥曲肽在婴幼儿心胸术后乳糜胸的临床疗效.方法 回顾性分析2003年7月至2011年11月间心胸手术后并发乳糜胸15例临床资料,15例分为对照组(9例)和奥曲肽组(6例),两组病例的年龄、体重、术后发生乳糜胸时间等一般资料间差异无统计学意义,乳糜胸的诊断标准一致.分析比较两组病例治疗前、治疗中乳糜胸引流量的变化、治愈时间等数据.两组的数据用均数及标准差(-x±s)表示,组间比较采用成组设计资料的t检验,组内比较采用配对t检验,P＜ 0.05(或P＜0.01)差异有统计学意义.结果 对照组胸引流量在治疗后72 h[(214.4±130.2) ml/d]、1周[(155.5±86.7) ml/d]较治疗前[(256.6±125.2) ml/d]明显减少(t=5.041,4.623;P=0.001,0.002).对照组胸引流量治疗后2周[(142.3±120.3)ml/d]、3周[(139.4±113.4) ml/d]较治疗前无明显减少(t=2.099,1.745;P=0.069,0.119).对照组有3例保守治疗无效,其中2例手术治疗,1例死亡.奥曲肽组6例保守治疗成功.胸引流量在治疗后72 h[(88.3±22.2) ml/d]、1周[(51.2±16.7) ml/d]、2周[(19.3±6.05)ml/d]较治疗前明显减少(t=5.227,5.549,6.638;P=0.003,0.003,0.002).两组胸引流量在治疗72 h、1周、2周间间差异有统计学意义(t=2.453,2.900,2.412;P=0.029,0.012,0.031).两组保守治愈病例术后痊愈时间[对照组(32.8±0.75)d;奥曲肽组(25.2±1.78) d]差异有统计学意义(t=2.512;P=0.028).结论 奥曲肽的使用能明显促进婴幼儿术后乳糜胸恢复,应积极使用.     

Thoracic duct embolization: a new treatment for massive leak after neck dissection

Chylothorax results from injury to the thoracic duct or one of its branches. It is an uncommon but possibly serious complication of thoracic or head and neck surgery. We report a case of thoracic duct transection complicating a total laryngectomy with bilateral selective neck dissection for subglottic squamous cell carcinoma. High-output Jackson Pratt drainage was noted, resulting in patient hypovolemia that was unresponsive to volume resuscitation. Treatment consisted of percutaneous embolization of the thoracic duct proximal to the transection that subsequently normalized chylous output.     

胸导管低位集束结扎在预防食管癌食管胃胸顶吻合术后乳糜胸的应用

目的探讨低位集束结扎在预防食管癌切除术后乳糜胸的应用价值。方法术中在下肺静脉平面（TR水平）双7号丝线将包括胸导管在内的束状组织一并结扎。结果489例食管癌切除后,无一例术后乳糜胸。结论用低位胸导管大块结扎预防食管癌切除术后乳糜胸操作简便,是降低食管癌术后乳糜胸的有效方法。     

Three cases of bilateral chylothorax developing after neck dissection

Only 16 cases of bilateral chylothorax following neck dissection have been reported within 10 decades. In this paper, three cases of bilateral chylothorax which developed after neck dissection are reported. In all cases, conservative treatment resulted in resolution of the condition. Diagnosis may be delayed in those who are on total parenteral nutrition, and therefore particular attention should be paid to those patients. It may be difficult to treat cases of chylothorax that develop following neck dissection performed after radiotherapy.