Chan B B, Murphy M C, Rodgers B M
Department of Surgery, Children's Medical Center, University of Virginia Health Sciences Center, Charlottesville 22908.
J Pediatr Surg. 1990 Nov;25(11):1185-9. doi: 10.1016/0022-3468(90)90761-w.
Chylopericardium is a rare entity that may be congenital in origin or secondary to surgical trauma, mediastinal lymphangiomas-hygromas, or radiation. Current treatment progresses from dietary medium-chain triglycerides and pericardiocentesis, to pericardial drainage, to thoracotomy with pericardiectomy and thoracic duct ligation. Between January 1986 and January 1989, we treated four children with chylopericardium: three secondary to mediastinal lymphangioma-hygroma, and one following cardiac surgery. The patients ranged in age from newborn to 16 years. All had signs of cardiac tamponade and three underwent initial pericardiocentesis or tube drainage. One 6-week-old infant with a mediastinal cystic hygroma developed chylopericardium following resection of the hygroma and responded to 9 days of tube drainage. The remaining children did not respond to repeated pericardiocenteses or prolonged drainage and underwent pericardial-peritoneal shunting with Denver shunts. The shunt was removed in 14 days in one patient. One patient had the shunt exteriorized for 8 weeks and one patient continues to use the shunt after 3 years. The chylopericardium resolved in each case without recurrence. Pericardial-peritoneal shunting provides a simple and effective alternative to prolonged pericardial drainage or thoracotomy in patients with chylopericardium of various etiologies.
乳糜性心包炎是一种罕见的病症，其病因可能是先天性的，也可能继发于手术创伤、纵隔淋巴管瘤-水囊瘤或放疗。目前的治疗方法从饮食中使用中链甘油三酯和心包穿刺术，发展到心包引流，再到开胸心包切除术和胸导管结扎术。1986年1月至1989年1月期间，我们治疗了4例乳糜性心包炎患儿：3例继发于纵隔淋巴管瘤-水囊瘤，1例继发于心脏手术后。患者年龄从新生儿到16岁不等。所有患者均有心脏压塞的体征，3例接受了初始心包穿刺术或置管引流。1例6周大患有纵隔囊性水囊瘤的婴儿在切除水囊瘤后发生乳糜性心包炎，经9天置管引流后病情好转。其余患儿对反复心包穿刺术或长期引流均无反应，遂接受使用丹佛分流管进行心包-腹膜分流术。1例患者在14天后拔除分流管。1例患者将分流管外置8周，1例患者在3年后仍继续使用分流管。每例患者的乳糜性心包炎均得以治愈，未复发。对于各种病因导致的乳糜性心包炎患者，心包-腹膜分流术为长期心包引流或开胸手术提供了一种简单有效的替代方法。
