Eda T, Ichihara T, Asakura T, Nishimura M, Yamakawa K, Ueda Y
Department of Cardiovascular Surgery, Tosei General Hospital, Seto, Japan.
Kyobu Geka. 2002 Nov;55(12):1035-8.
A 77-year-old female with Stanford B chronic aortic dissection, received elective replacement of descending aorta. The aorta distal to the aneurysm was encircled with a tape, and replaced using the double barrel technique. After the operation, chest X-ray showed effusion on the bilateral side. The amount of milky fluid from drain increased to 2,000 ml per day. The chemical profiles of the fluids were compatible with chylothorax. The Thoracic duct near the diaphragm was closed through left mini-thoracotomy. But the leakage of chyle did not cease. The lymphoscintigraphy showed a leakage to right lower intrathorax near the diaphragm and native aorta. A defect of the thoracic duct was closed, and chylothorax was cured. This case shows that though detailed anatomical structure of thoracic duct is not revealed, lymphoscintigraphy is useful for the localization of leakage in patients with chylothorax of post-cardiovascular-surgery.
一名77岁患有斯坦福B型慢性主动脉夹层的女性接受了降主动脉择期置换术。动脉瘤远端的主动脉用一条带子环绕，采用双筒技术进行置换。术后胸部X线显示双侧胸腔积液。引流管引出的乳糜液量增至每天2000毫升。液体的化学分析结果与乳糜胸相符。通过左胸小切口封闭了膈肌附近的胸导管。但乳糜漏并未停止。淋巴闪烁造影显示在膈肌和主动脉近端附近的右下胸腔有渗漏。封闭了胸导管的一处缺损，乳糜胸得以治愈。该病例表明，尽管胸导管的详细解剖结构尚未明确，但淋巴闪烁造影对于心血管手术后乳糜胸患者渗漏部位的定位是有用的。
