ObjectiveTo investigate the clinical characteristics, diagnosis and management of postoperative chylothorax after congenital cardiac surgery in infants and children. MethodsWe retrospectively analyzed clinical data of 79 postoperative patients with chylothorax after congenital cardiac surgery in Guangdong General Hospital between January 2006 and December 2013.There were 54 males and 25 females at age ranged 8 days to 14 years. ResultsThe prevalence of postoperative chylothorax was 0.6% (79/12 067). A total of 75 (94.9%) patients were cured. And 71 patients (89.9%) were cured by conservative treatment. While 4(5.1%) patients received operative treatment, including 3 patients undergoing ligation of thoracic duct, 1 patient undergoing lymphatic ablation. There were 4 (5.1%) patients failed to treat, including 1(1.3%) abandoned, 3 (mortality of 3.8%) deaths in hospital for low cardiac output syndrome, cardiac arrest and severe anastomotic stenosis after transposition of conducting arteries(TGA), tetralogy of Fallot(TOF) and total anomalous pulmonary venous connection(TAPVC) operation respectively. Hospitalization time ranged 10 to 108 (39.3±19.4) d. There was no recurrence of chylothorax within 6 months to 8 years of following-up. ConclusionThe key to prevention of chylothorax is to improve the surgical technology. Conservative management of chylothorax will be successful in most cases, but surgical treatment ought to be considered if the conservative management is unsuccessful.
ObjectiveTo review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.MethodsA total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.ResultsIncluded patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2±4 680.3 mL vs. 4 911.2±3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2±2.7 d) was shorter than that of the non-surgical treatment group (12.3±6.8 d, P=0.204).ConclusionThe treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.
ObjectiveTo investigate the caring method for neonatal chylothorax. MethodsWe retrospectively analyzed the clinical data of four hospitalized patients admitted from December 2011 to February 2013. ResultsThe treatment course lasted from 7 to 43 days, averaging 25 days. Three patients were cured and discharged from the hospital; one patient with ineffective outcome by conservative treatment was turned into surgical operation. ConclusionIn order to facilitate the recovery of the neonates suffering from neonatal chylothorax, it is important for us to ensure appropriate dietary management, total parental nutrition support, observation and care of closed drainage tube of thoracic cavity, accurate medication, safe intravenous fluids access and infection control.
目的 探讨经右胸入路胸腔镜下胸导管结扎在乳糜胸治疗中的作用及优势。 方法 回顾性分析南京军区南京总医院心胸外科 2012～2014 年采用胸腔镜手术治疗乳糜胸 18 例患者的临床资料，男 15 例、女 3 例，年龄 56～79（66.56±6.43）岁。所有患者均采用右胸入路胸腔镜辅助下行胸导管结扎，术中若能找到明显破口，则在破口的两端用 Ham-lock 夹闭胸导管，若未能找到明确的胸导管破口，则在第 8、第 9 胸椎附近用 Ham-lock 将胸导管及周围脂肪组织一起夹闭。 结果 全组 18 例患者均完成手术，无中转开胸，手术时间 28～45（35.83±4.58）min，术后胸腔引流时间 2～5（3.33±1.03）d，术后住院时间 5～8（6.11±1.02）d。术后无感染、吻合口瘘等严重并发症，随访 3 个月无复发。 结论 经右胸入路胸腔镜辅助手术结扎胸导管治疗乳糜胸是一种安全、有效的治疗方法，因其微创、住院时间短、手术效果确切等优点，值得在临床上推广。