Altuncu Emel, Akman Ipek, Kiyan Gürsu, Ersu Refika, Yurdakul Ziya, Bilgen Hülya, Ozdoğan Tutku, Ozek Eren
Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey.
Turk J Pediatr. 2007 Oct-Dec;49(4):418-21.
Chylothorax is the most common cause of pleural effusion in the newborn. We report three patients with congenital chylothorax and discussed the clinical course and treatment options. Cases 1 and 2 with congenital chylothorax were treated by chest tube placement and total parenteral nutrition (TPN), and were fed a formula rich in medium-chain triglyceride. They were discharged home without any sequelae. Our 3rd case with chylothorax did not respond to the conventional therapies. Octreotide infusion was tried without any benefits and necessitated surgical intervention, but the infant developed chronic lung disease requiring nasal oxygen therapy until three months of age. All three patients developed complications of chylothorax treatment like chest tube dysfunction, pneumothorax, nosocomial sepsis, and cholestasis. Management of congenital chylothorax necessitates a multidisciplinary approach. Treatment options include pleural drainage, cessation of enteral feeding and initiation of TPN. Experience with octreotide treatment is limited. Surgery should be reserved for severe and refractory cases.
乳糜胸是新生儿胸腔积液最常见的原因。我们报告了3例先天性乳糜胸患者，并讨论了其临床病程及治疗选择。病例1和病例2的先天性乳糜胸患者接受了胸腔闭式引流和全胃肠外营养（TPN）治疗，并给予富含中链甘油三酯的配方奶喂养。他们出院时无任何后遗症。我们的第3例乳糜胸患者对传统治疗无反应。尝试使用奥曲肽输注但未取得任何效果，因此需要进行手术干预，但该婴儿出现了慢性肺病，需要鼻导管给氧治疗直至3个月大。所有3例患者均出现了乳糜胸治疗的并发症，如胸腔闭式引流功能障碍、气胸、医院获得性败血症和胆汁淤积。先天性乳糜胸的管理需要多学科方法。治疗选择包括胸腔引流、停止肠内喂养并开始TPN。奥曲肽治疗的经验有限。手术应保留用于严重和难治性病例。
