Department of Pediatric Cardiothoracic Surgery, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
Department of Pediatric Cardiology, Le Bonheur Children's Hospital and University of Tennessee Health Science Center, Memphis, Tenn.
J Thorac Cardiovasc Surg. 2017 Dec;154(6):2062-2068. doi: 10.1016/j.jtcvs.2017.08.002. Epub 2017 Aug 17.
Medically refractory chylous pleural effusion after congenital heart surgery is associated with significant morbidity and mortality, especially in infants. We reviewed our experience with diaphragmatic fenestration procedure in this group of patients.
A retrospective chart review of all patients who had diaphragmatic fenestrations for chylous effusion at our institution over a 2-year period was performed.
A total of 9 diaphragmatic fenestration procedures were performed in 8 patients who had failed medical management of chylous pleural effusions. All procedures except 1 were performed on the right side. The median age at time of procedure was 4.6 months (range, 3 weeks to 14 months). The average time between primary congenital cardiac surgery and fenestration was 26 days (range, 4-53 days). Three patients had single ventricle repair. Average time of chest tube removal after procedure was 4 days. Average time to extubation was 3 days. All patients but 1 were able to advance to full feedings without reaccumulation of chylous effusion within 12 days. No complications developed in the patients. Recurrent effusion over a median follow-up period of 19 months did not develop in the patients.
Diaphragmatic fenestration is an effective and safe strategy for management of persistent chylous effusions after congenital cardiac surgery.
先天性心脏病手术后出现医学难治性乳糜性胸腔积液与显著的发病率和死亡率相关，尤其是在婴儿中。我们回顾了我们在这组患者中使用膈肌开窗术的经验。
对我院在 2 年内因乳糜性胸腔积液而行膈肌开窗术的所有患者进行回顾性图表分析。
8 例乳糜性胸腔积液经药物治疗失败的患者共行 9 次膈肌开窗术。除 1 例外，所有手术均在右侧进行。手术时的中位年龄为 4.6 个月（范围，3 周至 14 个月）。初次先天性心脏手术后至开窗术的平均时间为 26 天（范围，4-53 天）。3 例患者行单心室修复术。术后平均拔管时间为 4 天。平均拔管时间为 3 天。除 1 例患者外，所有患者均能在 12 天内恢复全量喂养而无乳糜性积液再积聚。所有患者均未发生并发症。在中位随访 19 个月期间，患者均未出现复发性胸腔积液。
膈肌开窗术是治疗先天性心脏病手术后持续性乳糜性胸腔积液的有效且安全的策略。
