Kamiya Kazunori, Yoshizu Akira, Fukutomi Toshinori, Sakuma Hisashi, Yabuno Taichi, Sato Akira, Okamoto Hiroaki, Nishimura Junichi
Gen Thorac Cardiovasc Surg. 2015 Dec;63(12):667-9. doi: 10.1007/s11748-014-0394-x.
A 52-year-old female with a history of past surgery for arteriovenous malformation of the thoracic spinal cord presented with left chylothorax. Lymphangiography identified diffuse lymphatic vessel (LV) growth with ectasia at the left supradiaphragmatic level. On the right side, the LVs were absent due to previous surgery. Given the ineffectiveness of conservative management, the patient required surgery. Thoracotomy showed extensive pleural fibrosis, lung atelectasis, and diffuse chyle defluxion on the parietal pleura. The diffuse chyle defluxion was not resolved by ligation. Therefore, we performed pedicled omentoplasty to fill the pleural space and to utilize its drainage and angiogenic capacity. Two years after the procedure, there was no sign of relapse. There are very few reports of refractory chylothorax successfully treated by pedicled omentoplasty. The procedure would be useful for the treatment of chylothorax when non-surgical or typical surgical management fails.
一名52岁女性，既往有胸段脊髓动静脉畸形手术史，现出现左侧乳糜胸。淋巴管造影显示左侧膈上水平淋巴管弥漫性生长并伴有扩张。右侧由于既往手术，淋巴管缺如。鉴于保守治疗无效，患者需要手术。开胸手术显示广泛的胸膜纤维化、肺不张以及壁层胸膜弥漫性乳糜渗漏。结扎未能解决弥漫性乳糜渗漏问题。因此，我们进行了带蒂大网膜成形术以填充胸膜腔并利用其引流和血管生成能力。术后两年，无复发迹象。关于带蒂大网膜成形术成功治疗难治性乳糜胸的报道非常少。当非手术或传统手术治疗失败时，该手术对乳糜胸的治疗将很有用。
