Parshin V D
Sechenov First Moscow State Medical University of Ministry of Health, Moscow, Russia.
Khirurgiia (Mosk). 2016(7):36-44. doi: 10.17116/hirurgia2016736-44.
to improve the results and current pathogenetic treatment of chylorrhea.
Thirty seven patients with chylothorax have been treated for the period 2004-2014. In 34 cases traumatic chylothorax developed after surgery and in 3 cases - after intensive care for therapeutic diseases and great veins catheterization. Chylothorax was predominantly diagnosed by X-ray method. Herewith, hydrothorax was established and its nature was defined using laboratory survey. Presence of neutral fat in pleural drainage is the sign of chylothorax. Pathogenetic treatment was often delayed (up to 4.5 months) due to poor awareness of physicians about this pathological process. 6 patients underwent thoracic duct ligation above diaphragm due to ineffective therapy.
Medical therapy had good clinical effect in 83.8% of cases. Postoperatively 1 patient died for single lung inflammation on background of postoperative chylothorax after right-sided pneumonectomy. In other cases chylothora was eliminated with no recurrence in remote postoperative period. It is difficult to recognize injury of thoracic duct or its great branches during surgery. In these cases prolonged thoracic duct ligation above diaphragm is indicated.
改善乳糜胸的治疗效果及当前的病因治疗。
2004年至2014年期间对37例乳糜胸患者进行了治疗。34例创伤性乳糜胸在手术后发生，3例在治疗疾病的重症监护及大静脉置管后发生。乳糜胸主要通过X线方法诊断。同时，通过实验室检查确定胸腔积液并明确其性质。胸腔引流液中存在中性脂肪是乳糜胸的征象。由于医生对这一病理过程认识不足，病因治疗常常延迟（长达4.5个月）。6例患者因治疗无效接受了膈上胸导管结扎术。
药物治疗在83.8%的病例中具有良好的临床效果。术后1例患者在右侧肺切除术后因术后乳糜胸并发单肺炎症死亡。在其他病例中，乳糜胸得以消除，术后远期无复发。手术中很难识别胸导管或其主要分支的损伤。在这些情况下，建议进行膈上胸导管长期结扎术。
