Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
Section of Pediatric Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, Michigan.
J Surg Res. 2020 Dec;256:433-438. doi: 10.1016/j.jss.2020.07.005. Epub 2020 Aug 11.
Severe congenital chylothorax (SCC) may result in respiratory failure, malnutrition, immunodeficiency, and sepsis. Although typically managed with bowel rest, parenteral nutrition, and octreotide, persistent chylothoraces require surgical management. At our institution, a pleurectomy, unilateral or bilateral, in combination with mechanical pleurodesis and thoracic duct ligation is performed for SCC, and we describe our approach and outcomes.
We reviewed over 15-year period neonatal patients with SCC managed surgically with pleurectomy after medical therapy was unsuccessful. Patients were divided into two groups: those who underwent pleurectomy within 28 d of diagnosis (early group) and those who underwent pleurectomy after 28 d (late group). Resolution of chylothorax was defined by the absence of clinical symptoms as well as absent or minimal pleural effusion on chest X-ray.
Of 40 patients diagnosed with SCC over the study period, 15 underwent pleurectomy, eight early [mean time to operation = 20 (IQR 17, 23) d] and 7 late [59 (42, 75) d, P = 0.001]. Overall survival was 67% (10 of 15). Seven of 8 (88%) neonates who underwent early pleurectomy survived versus 3 of 7 (43%) who underwent late pleurectomy (P = 0.07). Length of stay was lower in the early group than the late group [73 (57, 79) versus 102 (109, 213) d, P = 0.05]. All patients who survived to discharge had resolution of their chylothorax.
Pleurectomy with mechanical pleurodesis and thoracic duct ligation is effective in the management of severe congenital chylothorax. When performed earlier, pleurectomy for severe congenital chylothorax may be associated with improved survival and shorter hospital length of stay.
严重先天性乳糜胸（SCC）可能导致呼吸衰竭、营养不良、免疫缺陷和败血症。尽管通常采用肠道休息、肠外营养和奥曲肽治疗，但持续性乳糜胸需要手术治疗。在我们的机构中，对于 SCC，采用单侧或双侧胸膜切除术，结合机械性胸膜固定术和胸导管结扎术进行治疗，我们描述了我们的方法和结果。
我们回顾了超过 15 年期间接受过胸膜切除术治疗的 SCC 新生儿患者，这些患者在药物治疗无效后接受了手术治疗。患者分为两组：在诊断后 28 天内接受胸膜切除术的早期组（n=8）和在 28 天后接受胸膜切除术的晚期组（n=7）。乳糜胸的解决定义为临床症状消失，以及 X 光胸片上胸腔积液消失或极少。
在研究期间，40 名被诊断为 SCC 的患者中有 15 名接受了胸膜切除术，其中 8 名在早期接受手术（手术时间的平均值为 20（IQR 17，23）天），7 名在晚期接受手术（59（42，75）天，P=0.001）。总生存率为 67%（10/15）。8 名早期接受胸膜切除术的新生儿中有 7 名存活，而 7 名晚期接受胸膜切除术的新生儿中有 3 名存活（P=0.07）。早期组的住院时间比晚期组短[73（57，79）天与 102（109，213）天，P=0.05]。所有存活出院的患者的乳糜胸均得到解决。
胸膜切除术联合机械性胸膜固定术和胸导管结扎术在严重先天性乳糜胸的治疗中是有效的。对于严重先天性乳糜胸，早期进行胸膜切除术可能与生存率提高和住院时间缩短有关。
