Fahimi H, Casselman F P, Mariani M A, van Boven W J, Knaepen P J, van Swieten H A
Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Ann Thorac Surg. 2001 Feb;71(2):448-50; discussion 450-1. doi: 10.1016/s0003-4975(00)02033-6.
This study was performed to review our experience with postoperative chylothorax and describe our current approach. In addition, we wanted to estimate the impact of video-assisted thoracoscopic surgery (VATS) on our current management policy.
From January 1991 to December 1999, 12 patients developed chylothorax after various thoracic procedures. Their mean age was 61.5 (range 31 to 80 years). The procedures were cardiac, aortic, and pulmonary operations.
All patients were initially treated conservatively. In addition, 7 patients needed surgical intervention, including one thoracotomy and six VATS. The site of thoracic duct laceration was identified and treated with VATS in 4 patients. In 2 patients, the leak could not be localized by VATS, and fibrin glue or talcage were applied in the pleural space. All patients were discharged without recurrent chylothorax.
VATS is an effective tool in the management of persisting postoperative chylothorax. Its easy use, low cost, and low morbidity rate suggest an earlier use of VATS in the treatment of postoperative chylothorax.
本研究旨在回顾我们在术后乳糜胸方面的经验并描述我们目前的处理方法。此外，我们想评估电视辅助胸腔镜手术（VATS）对我们当前管理策略的影响。
1991年1月至1999年12月，12例患者在接受各种胸部手术后发生乳糜胸。他们的平均年龄为61.5岁（范围31至80岁）。手术包括心脏、主动脉和肺部手术。
所有患者最初均接受保守治疗。此外，7例患者需要手术干预，包括1例开胸手术和6例VATS。4例患者通过VATS确定了胸导管撕裂部位并进行了治疗。2例患者的漏口无法通过VATS定位，于是在胸腔内应用了纤维蛋白胶或滑石粉。所有患者均出院，无复发性乳糜胸。
VATS是处理持续性术后乳糜胸的有效工具。其使用简便、成本低且发病率低，提示应更早地将VATS用于术后乳糜胸的治疗。
