Department of Cardiorespiratory Diseases, University of São Paulo School of Medicine, São Paulo, Brazil.
J Bras Pneumol. 2011 Jan-Feb;37(1):28-35. doi: 10.1590/s1806-37132011000100006.
To evaluate the use of video-assisted thoracoscopy in the surgical treatment of chylothorax developed after the surgical correction of congenital heart disease in children.
We reviewed the medical charts of 3,092 children who underwent surgery for congenital heart disease between February of 2002 and February of 2007 at the Heart Institute of the University of São Paulo School of Medicine Hospital das Clínicas, in São Paulo, Brazil.
Of the 3,092 children, 64 (2.2%) presented with chylothorax as a postoperative complication. In 50 (78.1%) of those patients, the clinical management was successful, whereas it failed in 14 (21.9%), all of whom were then submitted to thoracic duct ligation by video-assisted thoracoscopy. The thoracic duct ligation was successful in 12 patients (86%) but failed in 2. In the postoperative period, additional clinical measures, such as a low-fat diet and parenteral nutrition, were required in order to resolve those 2 cases. There was no surgical morbidity or mortality. Of the 14 patients who underwent thoracic duct ligation, 5 (35%) died due to cardiac or infectious complications.
Video-assisted thoracic duct ligation can be safely performed in patients with severe heart disease, and the outcomes are favorable.
评估胸腔镜辅助手术在儿童先天性心脏病手术后乳糜胸治疗中的应用。
我们回顾了 2002 年 2 月至 2007 年 2 月期间在巴西圣保罗大学医学院附属医院心脏病研究所接受先天性心脏病手术的 3092 名儿童的病历。
在 3092 名儿童中，有 64 名（2.2%）出现乳糜胸作为术后并发症。在这 50 名（78.1%）患者中，临床治疗成功，而 14 名（21.9%）患者治疗失败，所有患者随后均通过胸腔镜辅助胸导管结扎术进行治疗。12 名患者（86%）的胸导管结扎术成功，但 2 名患者失败。在术后期间，需要采取低脂饮食和肠外营养等其他临床措施来解决这 2 个病例。没有手术并发症或死亡。在接受胸导管结扎术的 14 名患者中，5 名（35%）因心脏或感染并发症死亡。
胸腔镜辅助胸导管结扎术可安全用于患有严重心脏病的患者，且结果良好。
