Doerr C H, Miller D L, Ryu J H
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Semin Respir Crit Care Med. 2001 Dec;22(6):617-26. doi: 10.1055/s-2001-18797.
Chylothorax or chylous pleural effusion occurs when chyle accumulates in the pleural space usually secondary to disruption of thoracic lymphatics. Chyle is a milky, white, opalescent fluid that is formed when long-chain triglycerides in the diet are transformed into chylomicrons and very-low-density lipoproteins, which are then secreted into intestinal lacteals. These lymphatic channels coalesce to form the thoracic duct, which transports chyle and ultimately drains it into the left subclavian vein. Any injury to the duct (or its major tributaries) as it courses through the thoracic cavity can lead to a chylous effusion. Diagnosis depends on direct analysis of the fluid by assaying the triglyceride content and, at times, lipid electrophoretic pattern (chylomicrons). Management depends on the underlying cause and the individual clinical circumstances. Nonoperative options include observation, treatment of the underlying disease, dietary modification employing strict medium-chain triglyceride diet or total parenteral nutrition, therapeutic thoracentesis, tube thoracostomy with chemical pleurodesis, and embolization of the thoracic duct. Surgical management may include pleurectomy, talc poudrage, pleuroperitoneal shunting, and repair or ligation of the thoracic duct via thoracoscopy or thoracotomy.
乳糜胸或乳糜性胸腔积液是指乳糜积聚于胸腔，通常继发于胸段淋巴管破裂。乳糜是一种呈乳状、白色、浑浊的液体，由饮食中的长链甘油三酯转化为乳糜微粒和极低密度脂蛋白后形成，随后被分泌入肠淋巴管。这些淋巴管汇合形成胸导管，胸导管输送乳糜并最终将其引流至左锁骨下静脉。胸导管（或其主要分支）在胸腔走行过程中受到的任何损伤都可能导致乳糜性胸腔积液。诊断依赖于通过检测甘油三酯含量以及有时检测脂质电泳图谱（乳糜微粒）对液体进行直接分析。治疗取决于潜在病因和个体临床情况。非手术治疗方法包括观察、治疗基础疾病、采用严格的中链甘油三酯饮食或全胃肠外营养进行饮食调整、治疗性胸腔穿刺、带化学性胸膜固定术的胸腔闭式引流以及胸导管栓塞术。手术治疗可能包括胸膜切除术、滑石粉喷洒、胸膜-腹膜分流术以及通过胸腔镜或开胸手术修复或结扎胸导管。
