Townshend Askari Pembe, Speake William, Brooks Adam
Adult Intensive Care Unit, Queen's Medical Centre, Nottingham, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.01.2009.1417. Epub 2009 May 12.
During a high speed road traffic accident, a 26-year-old man suffered multiple fractures of his thoracic vertebrae and bilateral pneumothoraces. The day after admission and commencement of nasogastric feeding, milky fluid was noted in his right chest drain. Feeding was stopped and a contrast oesophogram and oesophagoscopy were performed, which were normal. The chylothorax quickly resolved and both drains were removed on day 6. Initial treatment of chylothorax aims to decompress the pleural space and minimise chyle production by stopping enteral feeding. Most authors recommend conservative management for 2 weeks or more unless certain parameters are met: average daily chyle loss of >1.5 litres for a 5 day period, or imminent nutritional complications. In this case, surgical management of the chylothorax and spinal fractures was planned. However, conservative management was successful, highlighting the fact that early aggressive surgical intervention for chyle leaks in blunt trauma is not necessary.
在一次高速道路交通事故中，一名26岁男子胸椎多处骨折并双侧气胸。入院并开始鼻饲喂养后的第二天，其右侧胸腔引流管引出了乳状液体。停止喂养，并进行了食管造影和食管镜检查，结果均正常。乳糜胸很快得到缓解，第6天拔除了两根引流管。乳糜胸的初始治疗旨在通过停止肠内喂养来减压胸腔并尽量减少乳糜生成。大多数作者建议进行2周或更长时间的保守治疗，除非满足某些特定指标：连续5天平均每日乳糜损失量>1.5升，或即将出现营养并发症。在这种情况下，原本计划对乳糜胸和脊柱骨折进行手术治疗。然而，保守治疗取得了成功，这凸显了钝性创伤导致乳糜漏时早期积极手术干预并非必要这一事实。
