Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Am J Med Sci. 2010 Apr;339(4):314-8. doi: 10.1097/MAJ.0b013e3181cdcd6c.
Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (> or =18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77%) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59%). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27% versus 50%, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50% versus 13%, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.
乳糜胸是一种少见的胸腔积液形式，可由创伤性和非创伤性原因引起。对于乳糜胸患者，最佳的治疗方法和结果仍不明确。本回顾性单中心研究评估了 74 例（年龄≥18 岁）成人乳糜胸患者的治疗模式及其相关结局，并评估了淋巴管造影成像的作用。57 例（77%）患者初始治疗方法为非手术治疗，但最终有 44 例（59%）患者接受了手术治疗（胸膜固定术、胸导管结扎术和/或手术修复）。与创伤性病因患者相比，非创伤性乳糜胸患者初始治疗措施的缓解率明显更差（27%比 50%，P=0.048）。即使包括手术在内的其他治疗措施后，非创伤性乳糜胸患者的乳糜性胸腔积液复发率也明显高于创伤性组（分别为 50%比 13%，P<0.001）。淋巴成像似乎并没有明显影响治疗方法。对于创伤性乳糜胸患者，近一半的患者通过非手术方法可使乳糜胸得到缓解，但仅有少数非创伤性乳糜胸患者可缓解。大多数非创伤性乳糜胸患者最终需要手术治疗，但其中三分之一的患者仍无法解决乳糜胸问题。
