Bilateral chylothorax after transsternal total thymectomy: resolution with short period of fasting and total parenteral nutrition

Bilateral chylothorax after transsternal total thymectomy is very rare, but can be a serious complication. Disruption of minor lymphatic channels in the anterior mediastinum which is remote from thoracic duct is considered to be the cause of chylothorax. We report the case of bilateral chylothorax followed by thymectomy which was treated with pleural drainage, total parenteral nutrition, and fasting without octreotide injection.     

原发胆汁淤积性肝硬变合并乳糜胸老年患者1例

本文回顾了1例88岁男性原发胆汁淤积性肝硬变合并乳糜胸患者的诊治。患者以发热、咳嗽、咯痰伴喘憋为首发症状,入院后发现胸水并确诊为真性乳糜胸。排除了肿瘤、结核等乳糜胸的常见病因后,结合腹部CT及抗线粒体抗体M2亚型阳性,考虑为原发胆汁淤积性肝硬变导致乳糜胸形成。在内科保守治疗效果不佳的情况下,积极采取手术治疗,术后患者恢复好,多次复查胸片未见胸水生长。希望通过本病例,提高临床医师对老年乳糜胸的认识,做到早期诊断、综合治疗,以延长患者生存时间。     

先天性乳糜性心包积液1例报告并文献复习

目的报告1例先天性乳糜性心包积液并胸腔积液新生儿的临床表现、辅助检查与治疗转归。方法2010 - 07 - 05山东大学附属省立医院小儿重症医学科收治1例先天性原发性乳糜性心包积液并胸腔积液新生儿,回顾分析该患儿临床资料及诊疗过程,并复习国内外相关文献。结果该患儿产前超声检查即发现胎儿大量心包积液并胸腔积液,生后无明显症状,胸部正位X线片示心影增大（心胸比值0.75）,心脏超声示大量心包积液,胸部CT显示大量心包积液并左侧胸腔积液,心包穿刺抽液乳糜定性及生化检查证实积液性质为乳糜性;连续3次心包穿刺术无效后行心包闭式引流,放置导管持续性引流2d后痊愈;术后1周、1个月心脏超声检查无复发。结论原发性特发性乳糜性心包积液是一少见病症,多数病例仅能通过心包穿刺术证实诊断,心包穿刺及心包置管引流是有效的保守治疗手段,对复发性患者需要行手术治疗。     

颈清扫术后乳糜瘘和乳糜胸的诊断和治疗

目的:探讨颈清扫术后颈乳糜瘘及乳糜胸的发生原因、治疗方法.方法:34颈部乳糜瘘者采用颈部加压包扎+负压引流,4例在保守治疗无效后,改为手术探查结扎瘘口或胸导管.2例乳糜胸行保守治疗,1例保守治疗无效开胸结扎胸导管.结果:34例颈部乳糜瘘采用颈部加压包扎+负压引流后,30例痊愈,4例失败后经手术治疗痊愈,平均愈合时间10.2天(3-15天).两例乳糜胸经保守治疗痊愈,1例保守治疗无效开胸结扎胸导管治愈.结论: 颈部乳糜瘘和乳糜胸是少见的淋巴结清扫术后并发症,大多可以保守治疗治愈.     

胸腔内注射滑石粉悬液治疗食管癌术后乳糜胸

目的：探讨胸腔内注射滑石粉对食管癌术后乳糜胸的治疗价值。方法：回顾性分析1962年-2009年3562例食管癌术后45例乳糜胸患者胸腔内注射滑石粉的治疗效果。结果：乳糜胸的发生率为1.3%（45/3562）,25例（滑石粉悬液组）胸腔内注射滑石粉悬液后,22例治愈;17例（手术组）开胸行手术结扎胸导管＋胸腔内涂抹滑石粉治疗后16例治愈;死亡3例;滑石粉悬液组的治愈率为88%（22/25）,低于手术组的94.1%（16/17）,差异不显著（P〉0.05）。结论：用滑石粉混悬液胸腔内灌注治疗食管癌术后并发乳糜胸,疗效高、并发症轻,是一种简单、安全、有效的方法。     

Analysis of the etiology and treatment of chylothorax in 119 pediatric patients in a single clinical center

PurposeTo summarize the etiology and treatment of 119 patients with chylothorax in our hospital.MethodsA total of 119 patients with chylothorax, divided into a neonate group, an infant group, and an older-than-1-year group, were included in our study and analyzed from January 2000 to July 2017 in the Children’s Hospital of Chongqing Medical University.ResultsA total of 90 males and 29 females were included in our study. In the neonate group, 21 chylothorax cases were due to idiopathic factors, constituting 72.4% of the cases; 8 were related to cardiothoracic surgery, constituting 27.6%. In the infant group, 15 chylothorax cases were due to cardiothoracic surgery, constituting 55.6% of the cases; 11 were related to idiopathic factors, constituting 40.7%; and 1 was related to lymphoma, constituting 3.8%. In the older-than-1-year group, 33 chylothorax cases were due to idiopathic factors, constituting 52.4% of the cases; 25 were cardiothoracic surgery, constituting 39.7%; 2 were related to another internal medicine disease, constituting 3.2%; 2 were due to injury, constituting 3.2%; and 1 was related to lymphoma, constituting 1.6%. All the patients sequentially underwent thoracic drainage therapy, followed by fasting, thoracic injection of an adhesion-promoting agent, and thoracic duct ligation surgery. Among the neonates, 23 patients (79%) with fasting therapy improved, and 5 patients with fasting + intrapleural injection improved (17%). In the infant group, fasting promoted recovery in 14 patients, accounting for 51%, and fasting + thoracic injection improved the conditions of 10 patients, accounting for 37%. In the older-than-1-year group, fasting was effective in 35 patients, accounting for 55%; fasting + thoracic injection was effective in 22 patients, accounting for 34%; and fasting + thoracic injection + thoracic duct ligation surgery enabled the recovery of 2 patients, accounting for 3.2%.ConclusionIn our center, the main causes of chylothorax in the neonates group are idiopathic factors but may also include a history of unspecified birth trauma; the proportions of idiopathic factors in the infant and older-than-1-year groups are also higher, but the iatrogenic factors are significantly increased in the latter 2 groups. All the patients underwent thoracic drainage therapy, and fasting promoted the recovery of most children. When fasting was ineffective, subsequent thoracic injections were effective. If the above two methods failed, surgery was a method of choice, but it was not always effective.Level of EvidenceLevel IV.Type of StudyRetrospective study.     

The use of octreotide to treat congenital chylothorax

We report the use of the octreotide (a somatostatin analogue) in the treatment of idiopathic congenital chylothorax in a patient with Turner's syndrome who had previously failed conservative medical therapy. The patient improved rapidly after initiation of octreotide with complete resolution after 5 days of continuous therapy (10 μg/kg per hour).     

Does V-A ECMO increase the likelihood of chylothorax after congenital diaphragmatic hernia repair?

Background: The authors noticed a relatively large number of patients with congenital diaphragmatic hernia (CDH) repair after extracorporeal membrane oxygenation (ECMO) who had a chylothorax (CT). The data are reviewed.Methods: The charts of patients from 1990 until 2000 with CDH, treated with or without ECMO, together with the charts of patients treated with ECMO for other reasons and patients with esophageal atresia (EA) repair were reviewed. The diagnosis of CT was made if aspirated fluid appeared chylous and contained more than 90% lymphocytes or if the triglyceride level was more than 1.50 mmol/L.Results: Eighty-nine patients with CDH were analyzed. Postoperatively, 10% had a CT—21% in CDH patients with ECMO treatment and 6% in CDH patients without ECMO treatment. This difference appeared to be significant (P < .05). The presence of a patch as independent variable for the development of CT also showed significance (P < .05).Conclusions: Chylothorax presented in almost all cases as a left-sided fluid accumulation, and a patch was present in the majority of patients with CDH. Therefor, CT should be considered the result of the severity of the defect rather than the consequence of ECMO as a therapeutic modality.     

常规胸导管结扎预防食管癌术后乳糜胸

作者对202例中、上段食管癌病人术中常规行胸导管主干结扎术，术后无乳糜胸发生。讨论了胸导管的应用解剖，认为只要熟悉胸导管的解剖，无论使用何种方法，术中行胸导管结扎并不困难。最后认为，胸导管结扎是预防术后乳糜胸发生的有效方法，应此起重视。