Ohkura Yu, Ueno Masaki, Iizuka Toshiro, Haruta Shusuke, Tanaka Tsuyoshi, Udagawa Harushi
From the Department of Gastroenterological Surgery (YO, MU, SH, TT, HU), and Department of Gastroenterology (TI), Toranomon Hospital, Tokyo, Japan.
Medicine (Baltimore). 2015 Dec;94(49):e2214. doi: 10.1097/MD.0000000000002214.
Postoperative chylothorax is a rare but well-known complication of general thoracic surgery. Medical treatment of chylothorax was reported in the past, but there is still considerable controversy on the appropriate management strategies.Two patients with esophageal cancer underwent esophagectomy, 2-field lymph node dissection, and resection of thoracic duct together with ileocolic reconstruction via the retrosternal route at our hospital. Chylothorax developed on the 32nd postoperative day (POD) in 1 patient and the 12th POD in the other, manifesting as a change in the character of thoracic drainage to turbid white. Both were immediately started on octreotide (300 μg/ day) and etilefrine (120 mg/day). When the amount of pleural effusion decreased to <50 mL/day, we performed pleurodesis with Picibanil (OK432). Thereafter, the patients gradually made satisfactory progress and resumed oral food intake, and the thoracotomy tubes were eventually removed. They have remained recurrence-free at the time of writing.In this report, we demonstrated the clinical efficacy of etilefrine for the management of postesophagectomy chylothorax. New medical treatment options for this condition are now broad and the usefulness of combined therapy consisting of a sclerosing agent, etilefrine, and octreotide is underscored, regardless of the status of the thoracic duct.
术后乳糜胸是普通胸外科手术中一种罕见但广为人知的并发症。过去曾有乳糜胸药物治疗的报道，但在合适的管理策略上仍存在相当大的争议。我院有两名食管癌患者接受了食管切除术、二野淋巴结清扫术，并经胸骨后途径行胸导管切除及回结肠重建术。其中1例患者在术后第32天（POD）出现乳糜胸，另一例在术后第12天出现，表现为胸腔引流液性质变为浑浊白色。两人均立即开始使用奥曲肽（300μg/天）和乙苯福林（120mg/天）。当胸腔积液量减少至<50mL/天时，我们用沙培林（OK432）进行胸膜固定术。此后，患者逐渐取得满意进展并恢复经口进食，最终拔除开胸引流管。在撰写本文时，他们均未复发。在本报告中，我们展示了乙苯福林治疗食管切除术后乳糜胸临床疗效。目前针对这种情况的新药物治疗选择广泛，无论胸导管状况如何，硬化剂、乙苯福林和奥曲肽联合治疗的有效性都得到了强调。
