Rheuban K S, Kron I L, Carpenter M A, Gutgesell H P, Rodgers B M
Department of Pediatrics, University of Virginia Health Sciences Center, Charlottesville 22908.
Ann Thorac Surg. 1992 Jan;53(1):85-7. doi: 10.1016/0003-4975(92)90762-s.
Between 1980 and 1990, 10 of 12 children with a symptomatic chylothorax after operation for congenital heart disease failed to respond to traditional medical therapy (thoracentesis, tube thoracostomy, low-fat diet). All 10 patients underwent placement of a pleuroperitoneal shunt, with complete resolution of the chylothorax in 9 patients (90%). Cardiac catheterization, performed before placement of the pleuroperitoneal shunt in 5 patients, demonstrated elevated right atrial pressure in all patients (range, 10 to 25 mm Hg). The pleuroperitoneal shunt functioned effectively in 4 patients with moderately elevated right atrial pressures (range, 10 to 16 mm Hg; median, 13.5 mm Hg) but not in 1 patient with a right atrial pressure of 25 mm Hg. Pleuroperitoneal shunting as treatment for chylothorax after operation for congenital heart disease is safe and effective, even in the face of moderate elevations in right atrial pressure.
在1980年至1990年期间，12例先天性心脏病手术后出现症状性乳糜胸的儿童中，有10例对传统医学治疗（胸腔穿刺、胸腔闭式引流、低脂饮食）无反应。所有10例患者均接受了胸膜腹膜分流术，9例患者（90%）的乳糜胸完全消退。5例患者在放置胸膜腹膜分流术前进行了心导管检查，结果显示所有患者右心房压力均升高（范围为10至25 mmHg）。胸膜腹膜分流术在4例右心房压力中度升高（范围为10至16 mmHg；中位数为13.5 mmHg）的患者中有效，但在1例右心房压力为25 mmHg的患者中无效。胸膜腹膜分流术作为先天性心脏病手术后乳糜胸的治疗方法是安全有效的，即使面对右心房压力中度升高的情况也是如此。
