胸导管阻断在食管癌手术中的应用

目的探索使用安全、有效的胸导管阻断方法，以减少或避免食管癌手术后乳糜胸的发生．方法在熟悉胸导管解剖结构基础上，低位明视结扎之，近期使用染色技术使胸导管更易辨认，确定其形态并确定无遗漏后结扎．术后观察效果．结果文献报告食管癌术后乳糜胸的发生率为０．４～２．６％，本组２８０例术后无１例发生乳糜胸．结论食管癌手术中胸导管阻断应低位、明视、准确结扎，使用染色技术更易辨认．凡主动脉弓以上食管胃吻合者，均应便用胸导管阻断技术以进免术后乳糜胸的发生。     

胸导管结扎预防食管癌术后乳糜胸的临床研究

目的　寻找减少或消除食管癌切除术后乳糜胸发生率的有效方法。方法　随机选取 45例 (A组 )食管癌患者 ,在食管癌切除加胃 食管残端吻合时 ,一期行预防性低位胸导管结扎术 (第 8胸椎水平以下 ) ;另 92例 (B组 )作对照组 ,仅做食管癌切除加胃 -食管残端吻合术。结果　两组患者在术后乳糜胸发生率 (A :1/ 45 ;B :9/ 92 ,P =0 0 3)、术后 48h胸腔引流量〔第 1个 2 4h :A :(2 5 4 33± 45 15 )ml,B :(4 93 6 1± 76 6 7)ml;第 2个 2 4h :A :(141 11± 2 5 5 3)ml,B :(32 3 39± 5 8 17)ml;P <0 0 5 )〕、3天内拨管率 (A :94 78% ;B :6 2 2 1% ,P =0 0 0 1)、并发症 (A :3/ 45 ,B :0 / 92 ,P =0 0 34)以及随访锁骨上淋巴结转移 (A :0 / 45 ,B :9/ 92 ,P =0 0 3)等方面有统计学意义。结论　术中行预防性低位胸导管结扎术可明显减少甚至消除食管癌患者术后乳糜胸的发生。     

Chylothorax in chronic lymphocytic leukemia patient

Chronic lymphocytic leukemia (CLL) is rarely complicated by chylothorax: we present a 93-year-old woman with CLL who developed recurrent pleural effusions that were ultimately found to be chylous in nature. Despite eight repeated thoracenteses, she continued to experience re-accumulation of fluid, and therefore, video-assisted thoracotomy with mass ligation of the thoracic duct region plus pleurodesis was performed to resolve the chylothorax. Despite her age and underlying disease, she did well during follow-up. The etiology and management of chylothorax are also reviewed.     

Chylothorax in Henoch-Schonlein purpura: a case report and review of the literature

Henoch-Schonlein purpura (HSP) is the most common acute vasculitis in the pediatric population, with an incidence of 10-14 per 100,000. The classic presentation of this disorder includes erythematous papules followed by palpable purpura in the lower extremities, trunk, and face, arthralgia or arthritis, abdominal pain, gastrointestinal bleeding, and nephritis. While renal abnormalities in HSP are common, the classic pulmonary manifestations, such as hemorrhage and pneumonitis, are thought to be infrequent. Subclinical pulmonary manifestations, including diffusion defects and radiographic anomalies, seem to be quite frequent in patients with HSP but are not commonly reported. Other respiratory manifestations include pleural effusion and chylothorax, but these are rarely mentioned in the literature. Chylothorax was only reported once in an adult patient with HSP in whom the mechanism of formation was demonstrated to be secondary to transdiaphragmatic passage of chylous fluid from the peritoneal cavity. Here we describe an 8-year-old girl with HSP, nephrotic syndrome, and chylothorax, and we report the results of a review of the literature regarding respiratory complications in HSP. The present case is the first pediatric patient reported with HSP and chylothorax. The therapeutic measures utilized were effective in resolving her edema, ascites, and chylothorax, and we advocate the use of these measures as first-line therapy in future patients with similar complications from HSP.     

Surgical treatment of chylothorax caused by lymphangioleiomyomatosis

Lymphangioleiomyomatosis (LAM) is a rare progressive disease caused by infiltration of smooth muscle-like cells in lymph vessels as well as the lung. We report a case of pulmonary LAM in a 22-year-old female with shortness of breath, recurrent pneumothorax and chylous pleural effusions. Multiple ligation of thoracic in lower part of thoracic duct was performed and biopsy of thoracic duct confirmed the diagnosis of LAM. The operation was successful and the patient was discharged. Although the thoracic duct involvement is extensive, multiple ligation in lower part of thoracic duct may be a good choice.     

非创伤性乳糜胸的电视胸腔镜外科治疗(附4例报告及文献复习)

目的通过4例非创伤性乳糜胸的电视胸腔镜治疗，结合文献探讨非创伤性乳糜胸的病因、诊断和治疗方法。方法4例经临床、实验室、影像学及核医学检查确诊的非创伤性乳糜胸，经电视胸腔镜行胸导管结扎及胸膜固定术。结果3例1次治愈，1例复发，经2次手术治愈，随访1～5年未复发。结论电视胸腔镜外科为非创伤性乳糜胸提供了一种安全、微创及有效的方法。     

新生儿乳糜胸1例并文献复习

新生儿乳糜胸是新生儿期较罕见疾病,患儿出生早期即可出现呼吸衰竭,并因丢失大量淋巴液导致感染、营养不良、免疫低下等并发症而危及生命。本文通过一例病例报告及文献复习,就新生儿乳糜胸的临床表现、实验室检查、非增强MRI应用、以及保守治疗方法做一总结分析,以提高儿科临床医生在本病的诊断和治疗方面的认识。     

7例肺癌术后乳糜胸治疗体会

目的探讨肺癌术后并发乳糜胸的治疗方法.方法7例乳糜胸患者治疗临床资料的回顾性分析.结果6例乳糜胸患者均保守治疗治愈.1例乳糜胸患者经手术治愈.术后随访3月未发生乳糜胸.结论早期发现乳糜胸,积极保守治疗可取得良好效果,必要时采取手术治疗.     

Lymph Vessel Thrombus Detection in Cervical Lymphedema: A Case Series

Although thrombosis in the terminal part of thoracic duct has been described in patients with head and neck cancer and upper vein thrombosis, normally medical imaging is not successful in depicting such lymphatic thrombosis. This case series is about three patients with acute onset of cervical lymphedema following minor trauma or exceptional physical strain. Using high‐resolution ultrasound, it was possible to detect a thrombus formation in the terminal parts of the thoracic duct or the lymph duct. Within a few weeks all patients recovered without relapse for several years.