Sersar Sameh Ibrahim
Division of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Pediatr Surg Int. 2011 Aug;27(8):811-5. doi: 10.1007/s00383-011-2890-8. Epub 2011 Jun 10.
INTRODUCTION AND AIM OF THE WORK: Chylothorax is a clinical challenge. This study aims at determination of the predictors of prolonged drainage of chylothorax after cardiac surgery in a single tertiary centre in Jeddah, Saudi Arabia.
A retrospective analysis of 52 patients of chylothorax with a mean age of 30 months (range 1 month to 60 years) who developed chylothorax after heart surgery (January 2007-September 2010). Data were collected regarding patients demographics, procedures, chylous drainage and its management, complications and follow-up.
There was one hospital mortality. All patients were managed by fat-free diet or Monogen. Lone fat-free diet with steroids were used a in eight patients (15.4%). Somatostatin analogue (Octreotide) was used adjunctively in 7 (13.5%) patients and in two patients (3.8%), steroids and octreotide were used adjunctively. The median duration of chest tube drainage was 10.5 days (range 4-34 days). The median amount of chest tube drainage/kg/day was 18 mL (range 6.6-72 mL). All patients responded to medical treatment except one case who required thoracic duct ligation and a patient who died. The use of octreotide and steroids therapy significantly reduced the amount chest tube drainage. At median follow-up of 12 months (range 1-40 months) after hospital discharge, no recurrence of chylothorax was observed.
Chylothorax is much more common post-pediatric cardiac than post-adult cardiac surgery. Conservative therapy of chylothorax after cardiac surgery remains the standard approach. Steroids and or octreotide can be used with an acceptable success. The most significant predictor of prolonged chest tube drainage in chylothorax is triglyceride/cholesterol ratio more than 2.
工作的引言和目的：乳糜胸是一项临床挑战。本研究旨在确定沙特阿拉伯吉达一家三级中心心脏手术后乳糜胸长期引流的预测因素。
对52例乳糜胸患者进行回顾性分析，这些患者平均年龄为30个月（范围1个月至60岁），于心脏手术后发生乳糜胸（2007年1月至2010年9月）。收集了有关患者人口统计学、手术、乳糜引流及其管理、并发症和随访的数据。
有1例医院死亡。所有患者均采用无脂饮食或要素膳进行治疗。8例患者（15.4%）采用单纯无脂饮食加类固醇治疗。7例患者（13.5%）辅助使用生长抑素类似物（奥曲肽），2例患者（3.8%）同时辅助使用类固醇和奥曲肽。胸管引流的中位持续时间为10.5天（范围4至34天）。胸管引流的中位每日每千克量为18毫升（范围6.6至72毫升）。除1例需要进行胸导管结扎和1例死亡患者外，所有患者对药物治疗均有反应。奥曲肽和类固醇治疗显著减少了胸管引流量。出院后中位随访12个月（范围1至40个月），未观察到乳糜胸复发。
小儿心脏手术后乳糜胸比成人心脏手术后更为常见。心脏手术后乳糜胸的保守治疗仍然是标准方法。类固醇和/或奥曲肽的使用可取得可接受的成功。乳糜胸中胸管长期引流的最显著预测因素是甘油三酯/胆固醇比值大于2。
