Epaud Ralph, Dubern Beatrice, Larroquet Michele, Tamalet Aline, Guillemot Nathalie, Maurage Chantal, Clement Annick, Fauroux Brigitte
Hôpital Armand Trousseau, Université Pierre et Marie Curie-Paris 6, Paris, France.
J Pediatr Surg. 2008 Mar;43(3):461-5. doi: 10.1016/j.jpedsurg.2007.10.024.
The objectives of the study were to present our institutional experience of idiopathic chylothorax in children and to propose therapeutic strategies.
This was a retrospective, single-center study.
Patients were 6 children (4 boys, 2 girls) presenting with an idiopathic chylothorax diagnosed from the presence of a chylous pleural effusion with triglycerides greater than 1.2 mmol/L and a cellularity greater than 1000 cells/mL with a predominance of lymphocytes.
Median age of onset was 7 years (range, 2-14 years). Initial symptoms included cough (n = 4), tachypnea (n = 4), asthenia (n = 5), abdominal pain (n = 2), and bronchitis (n = 1). Chest radiography showed 2 left, 2 right, and 2 bilateral pleural effusions. Serum biology assessment was normal in all children. Respiratory function assessment at diagnosis revealed a decrease in functional residual capacity in 3 children and a decrease in lung diffusing capacity in 2 children. Initially, all patients received a medium-chain triglyceride diet for 29 months (range, 10-50 months). Total parenteral nutrition was required for 4 patients (for 1-4 months), and somatostatin was tried in one child. Two children required pleuroperitoneal shunting, bilateral in one case. During the follow-up (median duration, 6 years; range, 2-16 years), chylothorax stabilized in all patients and 5 patients were able to return to a normal diet.
A medium-chain triglyceride diet associated in some cases with total parenteral nutrition may stabilize idiopathic chylothorax in children. In cases where conservative treatment has failed, pleuroperitoneal shunting may be useful.
本研究的目的是介绍我们机构对儿童特发性乳糜胸的经验，并提出治疗策略。
这是一项回顾性单中心研究。
患者为6名儿童（4名男孩，2名女孩），因乳糜性胸腔积液诊断为特发性乳糜胸，胸腔积液甘油三酯大于1.2 mmol/L，细胞计数大于1000个细胞/mL，以淋巴细胞为主。
发病中位年龄为7岁（范围2 - 14岁）。初始症状包括咳嗽（n = 4）、呼吸急促（n = 4）、乏力（n = 5）、腹痛（n = 2）和支气管炎（n = 1）。胸部X线显示左侧胸腔积液2例，右侧2例，双侧2例。所有儿童血清生物学评估均正常。诊断时呼吸功能评估显示3名儿童功能残气量降低，2名儿童肺弥散功能降低。最初，所有患者接受中链甘油三酯饮食29个月（范围10 - 50个月）。4名患者需要全胃肠外营养（1 - 4个月），1名儿童试用了生长抑素。2名儿童需要行胸膜腹膜分流术，其中1例为双侧。在随访期间（中位持续时间6年；范围2 - 16年），所有患者乳糜胸病情稳定，5名患者能够恢复正常饮食。
中链甘油三酯饮食在某些情况下联合全胃肠外营养可能使儿童特发性乳糜胸病情稳定。在保守治疗失败的情况下，胸膜腹膜分流术可能有用。
