肺癌术后乳糜胸10例治疗分析

目的回顾肺癌切除和淋巴结清扫术后并发乳糜胸的病例,分析其治疗方法。方法845例肺癌患者行肺切除术并行系统淋巴结清扫。其中10例术后并发乳糜胸,6例采取胸腔闭式引流,全胃肠外营养等保守治疗,4例行低位胸导管结扎术。结果10例全部治愈。结论肺癌术后乳糜胸治疗根据个体情况采取个体化治疗均可达到治愈。     

Successful management of a chylothorax in infancy using a pleurectomy

The management of chylothorax is described in three infants. Because none of them had had a direct injury to the thoracic duct, it was suspected that the chylothoraces had a significant chance of recurrence after simple ligation of the duct. To avoid recurrence, formal stripping of the parietal pleura was performed using a technique not previously reported in the literature. The operation was simple to perform and resulted in resolution of the chylothorax in all infants. The three cases and details of the surgical procedure are described.     

Thoracoamniotic shunting for fetal pleural effusions with hydrops

OBJECTIVE: The purpose of this study was to evaluate perinatal outcome after thoracoamniotic shunting for fetal pleural effusions with hydrops. STUDY DESIGN: This was a retrospective study. RESULTS: Shunting was performed immediately after diagnosis and was successful in all 54 of the cases that were attempted. There were 7 pregnancy terminations, 9 in utero deaths, and 38 live births, of which 7 children died in the neonatal period and 31 children survived. Among the liveborn infants, 27 infants were delivered preterm (71%), of whom 7 infants (15%) had preterm premature rupture of membranes and 4 infants (8.5%) had chorioamnionitis. Perinatal death (23/54 infants; 43%) was related to underlying anomalies (7 cases), pulmonary hypoplasia (5 cases), chorioamnionitis (2 cases), or treatment failure for unknown reasons (9 cases). All 31 survivors had chylothorax; for 28 of the survivors, the chylothorax was primary, and for 3 survivors, the chylothorax was the result of right congenital diaphragmatic hernia, pulmonary sequestration, or Noonan syndrome. CONCLUSION: After the shunting, pleural effusion with hydrops has a 57% survival rate; premature delivery is the leading source of morbidity.     

食管癌术后并发乳糜胸的临床探析

目的通过对临床病例的分析,探讨食管癌术后并发乳糜胸的原因、诊断、治疗和预防方法。方法分析12例食管癌术后并发乳糜胸的临床资料。结果12例病例中5例采用保守治疗,7例采用手术治疗,全部病例均治愈。结论食管癌术后并发乳糜胸应积极治疗,疗效确切,同时多数乳糜胸是可以预防的。     

Percutaneous Management of High-Output Chylothorax: Case Reviews

Chylothorax carries significant mortality and morbidity. Patients with high-output chylothorax have traditionally been managed by surgical treatment if nonoperative management has proved unsuccessful. Newer, more recent percutaneous techniques used to treat chylothorax are safer and less invasive than surgery. We present three cases that have been successfully managed using these percutaneous techniques.     

A case of severe chylothorax after esophagectomy successfully treated by a new combination of continuous positive-pressure ventilation plus chemical pleurodesis

Postoperative chylothorax is an uncommon but well-recognized and potentially life-threatening complication of esophagectomy for esophageal cancer. Its management remains controversial. A 71-year-old man with cancer of the thoracic esophagus was admitted to our hospital. A standard curative esophagectomy with extensive lymphadenectomy was performed. Two days after operation, chest roentgenography and computed tomography showed a massive right pleural effusion. A thoracic tube was placed in the right pleural cavity. The drainage volume of pleural effusion increased (up to 1500 ml/day), and chylothorax was diagnosed. Conservative drainage was continued for 4 days, but chyle leakage persisted. Minocycline hydrochloride 200 mg diluted in 50 ml saline was infused into the right pleural cavity through the tube to seal the leak. The patient concurrently received continuous positive-pressure ventilation (CPPV). The effusion completely resolved 30 h after beginning this combined treatment. To our knowledge, the treatment of chylothorax by CPPV plus chemical pleurodesis has not been reported previously in the English-language literature. Our method is simple, rapid, and may be a treatment option for patients with persistent chylothorax after esophagectomy that does not respond to conservative management or for patients in whom surgery is contraindicated.     

选择性结扎胸导管预防食管癌术后乳糜胸

目的探讨选择性结扎胸导管在食管癌切除术中预防术后乳糜胸的作用。方法对2009年6月至2011年7月手术切除的食管癌265例患者的临床资料进行回顾性分析。将265例食管癌手术切除术病例分为两组。A组138例,术中常规预防性结扎胸导管;B组127例,为选择性结扎胸导管组,术中结扎胸导管51例、未结扎76例。结果术后发生乳糜胸A组6例(4.3%),B组为0例(0%)。结论在食管癌切除术中,选择性结扎胸导管可有效预防术后乳糜胸发生。     

77例食管癌术后乳糜胸的诊治分析

目的总结胸部手术后并发乳糜胸的诊治经验。方法回顾性分析77例胸部手术后并发乳糜胸的诊治情况与结局。结果治愈76例（98.70%）,其中保守治疗58例,治愈57例,1例因肺部感染呼吸衰竭放弃出院;手术治疗19例,均痊愈。结论食管癌术后乳糜胸发生率较低,应实施预防为主的综合治疗原则,积极的保守治疗可使大部分病人避免二次手术打击,注射500 g/L高渗葡萄糖治疗乳糜的方法比注射滑石粉效果好。若病情未能改善,果断实施手术是积极有效的治疗方式。     

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.