Gao C X
Zhonghua Wai Ke Za Zhi. 1989 Mar;27(3):164-5, 189.
Sixty-five cases of chylothorax treated at the Shanghai Chest Hospital over the past 30 years are reviewed. The causes of chylothorax in this series were mainly traumatic and postoperative (47/65). Two cases were associated with chylopericardium and another 2 with chylous sputum. The authors believe that untreated chylothorax is a serious, often life-threatening entity and that the following principles are applicable in its management: (1) If daily chyle loss exceeds 1000 ml in adults with no tendency of subsidence, surgery is indicated especially in the effusion may lead to disastrous nutritional and immunologic consequences; (2) Ligation of the thoracic duct is effective by a mass ligature encircling all tissues between the azygos vein and the aorta. The most favorable site for ligation is immediately above the diaphragm. Over dissection of the thoracic duct should be avoided; (3) The proper surgical approach is on the side of the effusion in unilateral chylothorax, but right side approach is preferred in case of bilateral chylothorax or when the origin of chylous fistula is unknown; (4) Pleurodesis is indicated for those cases if the duct is not obviously present or chyle comes from the pleural lymphatics. Concentrated glucose solution with or without Talc suspension is recommendable.
回顾了上海胸科医院过去30年中治疗的65例乳糜胸病例。该系列中乳糜胸的病因主要是创伤性和术后（47/65）。2例合并乳糜心包，另外2例合并乳糜痰。作者认为，未经治疗的乳糜胸是一种严重的、常危及生命的疾病，以下原则适用于其治疗：（1）如果成人每日乳糜丢失超过1000ml且无自行消退趋势，尤其是当积液可能导致灾难性的营养和免疫后果时，应进行手术；（2）通过环绕奇静脉和主动脉之间所有组织的大块结扎来结扎胸导管是有效的。最适合结扎的部位是在膈肌上方紧邻处。应避免过度解剖胸导管；（3）对于单侧乳糜胸，合适的手术入路是在积液侧，但对于双侧乳糜胸或乳糜瘘起源不明的情况，右侧入路更可取；（4）如果胸导管不明显或乳糜来自胸膜淋巴管，则对这些病例应进行胸膜固定术。推荐使用含或不含滑石粉悬液的浓缩葡萄糖溶液。
