Sziklavari Zsolt, Allgäuer Michael, Hübner Georg, Neu Reiner, Ried Michael, Grosser Christian, Szöke Tamas, Schemm Rudolf, Hofmann Hans-Stefan
Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Prüfeningerstrasse 86, 93049, Regensburg, Germany.
J Cardiothorac Surg. 2013 Apr 8;8:72. doi: 10.1186/1749-8090-8-72.
Chylothorax is characterized by the presence of chyle in the pleural cavity. The healing rate of non-operative treatment varies enormously; the maximum success rate in series is 70%. We investigate the efficacy and outcomes of radiotherapy for postoperative chylothorax.
Chylothorax was identified based on the quantity and quality of the drainage fluid. Radiation was indicated if the daily chyle flow exceeded 450 ml after complete cessation of oral intake. Radiotherapy consisted of opposed isocentric portals to the mediastinum using 15 MV photon beams from a linear accelerator, a single dose of 1-1.5 Gy, and a maximum of five fractions per week. The radiation target area was the anatomical region between TH3 and TH10 depending on the localization of the resected lobe. The mean doses of the ionizing energy was 8.5 Gy ± 3.5 Gy.
The median start date of the radiation was the fourth day after chylothorax diagnosis. The patients' mediastinum was radiated an average of six times. Radiotherapy, in combination with dietary restrictions, was successful in all patients. The median time between the end of the radiation and the removal of the chest tube was one day. One patient underwent wound healing by secondary intention. The median time between the end of radiation and discharge was three days, and the overall hospital stay between the chylothorax diagnosis and discharge was 18 days (range: 11-30 days). After a follow-up of six months, no patient experienced chylothorax recurrence.
Our results suggest that radiotherapy in combination with dietary restriction in the treatment of postoperative chylothorax is very safe, rapid and successful. This novel interventional procedure can obviate repeat major thoracic surgery and shorten hospital stays and could be the first choice in the treatment of postthoracotomy chylothorax.
乳糜胸的特征是胸腔内存在乳糜。非手术治疗的治愈率差异极大；系列研究中的最高成功率为70%。我们研究了放射治疗术后乳糜胸的疗效和结果。
根据引流液的量和性质确定乳糜胸。如果在完全停止口服摄入后每日乳糜流量超过450 ml，则进行放射治疗。放射治疗采用直线加速器产生的15 MV光子束，以对穿等中心野照射纵隔，单次剂量为1 - 1.5 Gy，每周最多照射5次。放射靶区为根据切除肺叶的位置确定的胸3至胸10之间的解剖区域。电离能量的平均剂量为8.5 Gy±3.5 Gy。
放射治疗的中位开始日期为乳糜胸诊断后的第4天。患者纵隔平均接受6次照射。放射治疗联合饮食限制在所有患者中均取得成功。放射治疗结束至拔除胸管的中位时间为1天。1例患者通过二期愈合实现伤口愈合。放射治疗结束至出院的中位时间为3天，乳糜胸诊断至出院的总住院时间为18天（范围：11 - 30天）。随访6个月后，无患者出现乳糜胸复发。
我们的结果表明，放射治疗联合饮食限制治疗术后乳糜胸非常安全、迅速且成功。这种新的介入方法可以避免再次进行大型胸外科手术，缩短住院时间，可能是开胸术后乳糜胸治疗的首选方法。
