肺癌术后乳糜胸的诊治

1996年 3月至 2 0 0 1年 3月 ,我们手术治疗 1 1 2 0例肺癌病人 ,发生乳糜胸 8例 ,占 0 71 %。现总结报道如下。临床资料　 8例中男 7例 ,女 1例 ;年龄 33～ 72岁。其中左全肺切除 1例 ,左上叶切除 3例 ,右上叶切除 2例 ,右中下叶切除 2例。均广泛清扫纵隔及隆凸下淋巴结 ,但术后病理证实仅 4例有淋巴结转移。病人术后每日胸腔引流量大于1 0 0 0ｍｌ者 2例 ,另 6例均在 1 0 0～ 60 0ｍｌ间。 5例为典型的乳白色浊液 ,另 3例为淡红或灰黄色液。经实验室检查 ,诊断为乳糜胸。结果　 6例病人经保守治疗 1周痊愈 ;1例第 3ｄ仍引流出乳白色液 1 …     

胸导管结扎预防食管癌术后乳糜胸

胸导管结扎预防食管癌术后乳糜胸张安庆，董正，刘正光，林刚，李伟食管癌术后乳糜胸是一种不十分罕见的并发症，且后果严重。国内大量临床资料统计，其发生率为０．４％～２．６％，主要发生在中上段食管癌术后［１］。是否应当在食管癌手术中结扎胸导管预防术后乳糜胸尚...     

肺癌根治术后乳糜胸八例的诊治

我院自1998年3月～2005年3月，行肺癌根治术3000例，术后发生乳糜胸8例（0．27％），现将治疗经验总结如下。     

体外循环术后乳糜胸八例

体外循环术后乳糜胸八例梁家立张广福姜冠华王振祥１９８３年１月～１９９４年６月我院施行心内直视手术１８１２例。术后发生乳糜胸８例，发生率０．４４％，保守治疗６例，胸导管结扎２例，现报告如下。１临床资料本组共８例，男６例，女２例。年龄３～１２岁。法乐氏四...     

甲状腺癌颈部淋巴结清扫术后双侧乳糜胸及乳糜腹1例报告

正颈侧区淋巴结清扫术后发生乳糜胸的情况少见,尤其是双侧乳糜胸更为罕见~([1]),大量乳糜液压迫肺和纵膈可导致呼吸循环功能障碍而危及生命。甲状腺癌颈部淋巴结清扫术后发生双侧乳糜胸及乳糜腹文献尚无报道。笔者单位近期诊治1例甲状腺癌双侧颈侧区淋巴结清扫术后发生双侧乳糜胸及乳糜腹的病例。报道如下。     

肺癌与食管癌术后乳糜胸的比较

目的：探讨肺癌术后乳糜胸（肺癌组）与食管癌术后乳糜胸（食管癌组）的临床特点。方法：回顾分析4084例肺癌术后12例,以及4479例食管癌术后52例乳糜胸的临床特点。结果：肺癌组术后乳糜胸的发生率为0.29％,食管癌组为1.16％。肺癌组术后4d内确诊4例,食管癌组为40例（77％）。肺癌组出现典型乳糜样胸水者占83.3％,而食管癌组为5.8％。肺癌组患者的临床症状及体征明显较食管癌组轻。肺癌组再手术率为16.7％,食管癌组为96.2％。本组所有病例均痊愈出院。结论：肺癌术后乳糜胸的发生率、病因、临床表现、诊断、及治疗与食管癌术后乳糜胸有明显不同。     

先天性心脏病术后乳糜胸的诊治体会

目的分析先天性心脏病(以下简称先心病)术后并发乳糜胸的原因,探讨其治疗方法。方法回顾分析先心病术后并发乳糜胸9例,保守治疗5例,再次手术4例。结果2例再次手术后痊愈出院,1例再次手术后自动出院(转外院),1例术后出现全身功能衰竭而死亡,其余5例患者均保守治疗痊愈出院。结论先心病术后并发乳糜胸首先应考虑保守治疗,当保守治疗无效时应积极手术治疗。     

肺切除术后乳糜胸的临床诊治

1954年1月至2005年2月，我们行肺切除术18985例，其中32例并发乳糜胸，占同期肺切除术的0．17％。采取保守治疗19例、手术治疗13例，疗效满意，现报道如下。     

创伤引起胸段胸导管横断继发乳糜胸1例报告

患者 ,男 ,2 5岁 ,因乘摩托车摔伤而入院 ,着地部位不详。入院时 ,Ｐ 80次 /分 ,ＢＰ 16/ 12ｋＰａ ,意识清 ,瞳孔正圆等大 ,气管居中 ,胸廓对称无畸形 ,叩清音 ,肺肝浊音界右侧锁骨中线第 5肋间。两肺呼吸音清晰。心脏检查未发现异常。腹平坦 ,平脐出现外伤性截瘫 ,痛、温、触觉及各种反射消失 ,肌肉呈弛缓性瘫痪 ,膀胱无张力。胸椎Ｘ线片报告 :无外伤性骨折、错位、畸形。住院后给予限制液量、激素、脱水、消炎、止血等治疗 ,第 3天出现呼吸困难、咳嗽、气短、胸闷、颈静脉怒张、气管左移、右胸叩浊音、呼吸音减弱 ,胸穿抽出血性液体 ,经…     

Chylothorax Resulting from a Penetrating Injury of the Neck: a Case Report

Abstract  Chylothorax is characterized by an accumulation of lymphatic fluid in the pleural cavity due to compression or loss of integrity of the thoracic duct for any reason. It is frequently secondary to intrathoracic malignancies and iatrogenic trauma. Thoracic duct injury and resulting chylothorax, due to penetrating injuries of the neck, are very rare. This report presents a patient with chylothorax associated with penetrating neck trauma, who was successfully treated, and provides discussion on this very rare case in the light of the available literature.     

Current Concepts in the Management of Postoperative Chylothorax

Thirteen patients required pleural drainage for postoperative chylothorax with an average duration of leakage of 36.9 days. Total protein and albumin levels, body weight, and peripheral lymphocyte counts all decreased substantially during the period of chylous leakage. Only 3 chylothoraces resolved with tube drainage and dietary management alone. Six patients required eight operations for control of chylothorax, and 4 patients, all of whom had cancer, died with a persistent leak.Chylothorax is a debilitating postoperative complication resulting in an impaired immune system and nutritional state. Because it is associated with a 50% mortality in patients with cancer, early reoperation should be considered. Patients with benign underlying disease can be managed conservatively for longer periods. Control of potential chylous leaks at the time of original operation is vital, especially in patients with malignancies who have a predisposition toward leakage from sites other than the main thoracic duct.     

Postoperative Repeat Dislocation of the Posterior Tibial Tendon: A Case Report

Dislocation of the posterior tibial tendon is an uncommon condition. Although surgery is usually performed in most cases of posterior tibial tendon dislocation, postoperative repeat dislocation of the posterior tibial tendon has not been reported in the published data. We report the case of a 27-year-old male patient who experienced repeat dislocation of the posterior tibial tendon after a gymnastic landing, 44 months after initial retinaculum repair. For revision surgery, we reconstructed the flexor retinaculum in conjunction with deepening of the retromalleolar groove, because the groove was hypoplastic. He returned to competitive gymnastics and had not experienced subluxation or dislocation of the posterior tibial tendon at the 1-year follow-up examination.     

A Case of Everolimus-Associated Chylothorax in a Cardiac Transplant Recipient

We herein report a case of putative everolimus-associated chylothorax in a cardiac transplant recipient. A 17-year-old Japanese boy with dilated cardiomyopathy and severe cardiac failure requiring left ventricular assist support was determined to be a cardiac transplant candidate in 1992. He underwent overseas heart transplantation in Houston, Texas in October 1992. He was subsequently treated with immunosuppression therapy: Cyclosporine (CSA), azathioprine, and prednisolone (PRD). After several acute rejection episodes requiring steroid therapy, intravascular ultrasonography revealed a moderate degree of transplant coronary arterial vasculopathy (TCAV) with 50% stenosis in 2003. He underwent coronary stenting twice; the immunosuppressive regimen was converted to CSA, mycophenolate mofetil, everolimus (EVL), and PRD in 2006. TCAV has not progressed since then. In October 2008, chest x-ray showed bilateral pleural effusion. As we thought that the pleural effusion was caused by cardiac dysfunction due to moderate mitral regurgitation and TCAV as well as renal impairment, he was treated with diuretics and digoxin. However, the pleural effusion progressed gradually associated with exertional dyspnea and moderate edema of his lower legs. Chest computed tomography showed massive bilateral pleural effusions without evidence of malignancy in 2011. A pleural tap in 2011 revealed chylothorax. Although mammalian target of rapamycin inhibitors were major drugs for lymphoangioleimyomatosis, we believed that the chylothorax was associated with EVL. EVL was discontinued in March 2011: the chylothorax spontaneously resolved in November 2011.     

Late-Onset Chylothorax After Blunt Chest Trauma at an Interval of 20 Years: Report of a Case

We herein report an extremely rare case of a patient chylothorax at an interval of 20 years after thoracic vertebrae fractures, who underwent a successful thoracoscopic thoracic duct ligation and pleurodesis. A 51-year-old man was referred to our hospital with shortness of breath on effort about 1 month after participating in archery. Twenty years previously, he was involved in a traffic accident. At that time, the patient sustained trauma to the spine and suffered a spinal injury, thus resulting in paralysis in the lower part of his body. A chest roentgenogram and computed tomogram revealed a large amount of bilateral pleural effusion. After thoracentesis was performed, a diagnosis of chylothorax was made and the patient was hospitalized. Conservative management by a low-fat diet proved to be unsuccessful. The patient did not request pleurodesis, because pleural adhesions might impair pulmonary function. As a result, we decided to perform surgery. On the right side, we performed video-assisted thoracoscopic surgery by clipping the thoracic duct and applying an absorbable sealing material. Thereafter, pleurodesis was performed and OK-432 was instilled. Thereafter, the pleural fluid flow was almost completely stopped. On the left side, pleurodesis was effective. The patient has since remained symptom free and has been followed up on an outpatient basis for 9 months after the 100th postoperative day. We assumed that the chylothorax in this case was related to the earlier traffic accident.