Murphy M C, Newman B M, Rodgers B M
Department of Surgery, Children's Medical Center, University of Virginia Health Sciences Center, Charlottesville 22908.
Ann Thorac Surg. 1989 Aug;48(2):195-200. doi: 10.1016/0003-4975(89)90067-2.
Between June 1981 and June 1988, we placed pleuroperitoneal shunts in 16 patients for the management of refractory chylothorax on the Pediatric Surgical Service, University of Virginia. The cause of the chylothorax was caval thrombosis from central venous catheters in 5 patients, idiopathic in 3, and mediastinal lymphangioma in 2, and in 6, it developed after a cardiac procedure. Chylothorax in each patient was unresponsive to thoracentesis, tube thoracostomy, and dietary manipulations. A Denver double-valved shunt system is currently employed and is implanted using general anesthesia. Manual pumping is required postoperatively for several months. Twelve (75%) of the 16 patients had excellent results with complete elimination of the chylothorax and resolution of symptoms. In 10 of these 12, the shunt has been removed. Four had an unsatisfactory result: 3 had inferior vena cava hypertension, and 3 were low-birth-weight premature infants. Four patients seen early in this series required revision of the position of the pleural catheter, with successful drainage in each instance. Pleuroperitoneal shunting is a safe, simple, and effective treatment of chylothorax in infants and children. In view of our success in treating chylothorax with these shunts, we recommend early shunting before the development of nutritional or immunological depletion.
1981年6月至1988年6月期间，我们在弗吉尼亚大学儿科外科为16例患者置入了胸膜腹膜分流管，用于治疗难治性乳糜胸。乳糜胸的病因包括：5例因中心静脉导管导致的腔静脉血栓形成，3例为特发性，2例为纵隔淋巴管瘤，6例在心脏手术后发生。每位患者的乳糜胸对胸腔穿刺、胸腔闭式引流和饮食调整均无反应。目前采用丹佛双瓣分流系统，在全身麻醉下植入。术后需要手动泵注数月。16例患者中有12例（75%）效果极佳，乳糜胸完全消除，症状缓解。在这12例患者中的10例，分流管已被拔除。4例效果不佳：3例有下腔静脉高压，3例为低体重早产儿。本系列早期的4例患者需要调整胸膜导管的位置，每次均成功引流。胸膜腹膜分流术是治疗婴幼儿乳糜胸的一种安全、简单且有效的方法。鉴于我们使用这些分流管治疗乳糜胸取得的成功，我们建议在出现营养或免疫耗竭之前尽早进行分流。
