Schurz Mark, Petras Nina, Platzer Patrick, Hofbauer Friedrich, Vécsei Vilmos
Department of Trauma Surgery, Vienna Medical University, Vienna, Austria.
Department of General Surgery, General Hospital Oberpullendorf, Oberpullendorf, Austria.
Eur J Trauma Emerg Surg. 2010 Feb;36(1):76-80. doi: 10.1007/s00068-009-8127-z. Epub 2009 Mar 16.
Chylothorax is a very rare disease, and its diagnosis following blunt chest trauma is exceptional. Only a small number of cases have been reported in the literature. We report a case of a male patient involved in a car accident presenting a delayed chylothorax after blunt chest trauma with a bilateral serial rib fracture and fracture of the ninth thoracic vertebrae. The therapy includes thorax drainage, dietary modifications with total parenteral nutrition and, in severe cases, PEEP ventilation. Hematological monitoring is mandatory to detect metabolic abnormalities resulting from chyle loss. Surgical treatment is only required in cases of persistent or increasing intrathoracal chyle flow. Thoracoscopic ligation of the thoracic duct is then required.Severe consequences, such as cardiopulmonary abnormalities and metabolic, nutritional and immunologic disorders, can result from chylothorax. Our patient was treated successfully by chest drainage and parenteral nutrition.
乳糜胸是一种非常罕见的疾病,钝性胸部创伤后发生乳糜胸的情况极为罕见。文献中仅报道了少数病例。我们报告一例男性患者,该患者因车祸导致钝性胸部创伤,双侧多发性肋骨骨折及第九胸椎骨折后出现迟发性乳糜胸。治疗方法包括胸腔引流、采用全胃肠外营养进行饮食调整,严重时采用呼气末正压通气。必须进行血液学监测以检测因乳糜丢失导致的代谢异常。仅在胸腔内乳糜流量持续或增加的情况下才需要进行手术治疗,此时需要进行胸腔镜下胸导管结扎术。乳糜胸可能导致严重后果,如心肺异常以及代谢、营养和免疫紊乱。我们的患者通过胸腔引流和胃肠外营养治疗成功康复。