Petrella Francesco, Casiraghi Monica, Radice Davide, Bertolaccini Luca, Spaggiari Lorenzo
Department of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Lombardia, Italy.
Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Thorac Cardiovasc Surg. 2020 Sep;68(6):520-524. doi: 10.1055/s-0040-1710071. Epub 2020 Jun 3.
Chylothorax following pulmonary resection and lymphadenectomy for cancer is a potential severe complication in thoracic surgery. In the present study, we investigated the efficacy of the nonsurgical approach as well as the need for reoperation after conservative approach failure.
Chylothorax was diagnosed when chylous leakage from the chest drainage was observed and confirmed by the presence of triglycerides in the pleural fluid. We initially treated all the patients conservatively with complete oral intake cessation and total parenteral nutrition; if drainage output remained more than 800 mL/d after the first 5 days or major pleural effusion was observed at chest X-ray after chest tube removal, surgical treatment of chylothorax was indicated.
Between January 1998 and December 2018, 5,072 patients underwent standard anatomical resection and mediastinal lymph node dissection for cancer at our institution. Among them, 30 patients (0.6%) developed chylothorax: 20 patients were effectively treated only by nil per os and low-fat diet, while 10 patients (33.3%) required surgical treatment. Mean age was 63 years; there were 24 male patients (80%); right-sided chylothorax was more frequent than left-sided chylothorax (22 vs. 8, respectively) although not statistically significant ( = 0.38); the only factor that seems to influence the need for reoperation is chylothorax flow rate during conservative treatment ( = 0.06).
Conservative treatment is effective in the case of low flow-rate chylothorax (< 800 mL/d); in the case of a higher flow rate, surgical exploration is needed and thoracic duct ligation-with or without lymphatic sites clipping-provides definitive lymphostasis.
肺癌肺切除及淋巴结清扫术后乳糜胸是胸外科潜在的严重并发症。在本研究中，我们调查了非手术方法的疗效以及保守治疗失败后再次手术的必要性。
当观察到胸腔引流液中有乳糜漏出且胸腔积液中存在甘油三酯时，即可诊断为乳糜胸。我们最初对所有患者进行保守治疗，即完全停止经口摄入并给予全胃肠外营养；如果在最初5天后引流量仍超过800 mL/d，或拔除胸管后胸部X线检查发现大量胸腔积液，则需对乳糜胸进行手术治疗。
1998年1月至2018年12月，我院5072例患者接受了标准的肿瘤解剖性切除及纵隔淋巴结清扫术。其中，30例（0.6%）发生乳糜胸：20例仅通过禁食和低脂饮食得到有效治疗，而10例（33.3%）需要手术治疗。平均年龄为63岁；男性患者24例（80%）；右侧乳糜胸比左侧更常见（分别为22例和8例），尽管差异无统计学意义（P = 0.38）；唯一似乎影响再次手术必要性的因素是保守治疗期间的乳糜胸流量（P = 0.06）。
低流量乳糜胸（< 800 mL/d）时保守治疗有效；流量较高时，需要进行手术探查，胸导管结扎术（无论是否夹闭淋巴部位）可实现确切的淋巴封闭。
