Králík J, Tomsů M, Seidlová V
I. chirurgická klinika LF UP, Olomouc.
Rozhl Chir. 1990 Oct;69(10):659-62.
Traumatic chylothorax and chyloperitoneum are rare. Effusion of the chyle into the pleural cavity occurs after severe injuries of the chest wall after pretentious surgical operation in the posterior mediastinum and after operations of the cardiovascular system. The authors recorded one observation after operation of a patent ductus arteriosus and controlled the situation by a conservative procedure. A traumatic chyloperitoneum develops typically after a minor or obscure injury. The pathological picture usually develops slowly, in rare instances it imitates an acute abdomen. The condition calls for laparotomy. Only in rare instances a fissure is detected in the posterior peritoneum and it is very difficult to detect the sites of injuries of lymphatic vessels. The authors treated three patients. All were operated, two were subjected to laparotomy twice. A relapsing chyloperitoneum was brought under control by hitherto non published surgical procedures: in one instance by communication of the abdomen with the posterior mediastinum, in the second case by ligature of the lymphatic vessels close to the vasa mesenterica cran. All patients recovered.
创伤性乳糜胸和乳糜腹很少见。乳糜液渗入胸腔发生于胸壁严重损伤后、后纵隔复杂外科手术后以及心血管系统手术后。作者记录了1例动脉导管未闭手术后的观察情况,并通过保守治疗控制了病情。创伤性乳糜腹通常在轻微或隐匿性损伤后发生。病理表现通常发展缓慢,极少数情况下类似急腹症。这种情况需要进行剖腹手术。仅在极少数情况下可在后腹膜发现裂隙,且很难检测到淋巴管损伤部位。作者治疗了3例患者。均接受了手术,其中2例进行了两次剖腹手术。复发性乳糜腹通过此前未发表的外科手术得到控制:1例通过使腹部与后纵隔相通,另一例通过结扎靠近肠系膜上血管的淋巴管。所有患者均康复。