Sham Goby T W, Chung Patrick H Y, Chan Iris M C, Leung W C, Wong Kenneth K Y
Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China.
Transl Pediatr. 2020 Oct;9(5):702-706. doi: 10.21037/tp-20-74.
Thoracoamniotic shunt has been considered as a treatment for antenatal pleural effusion and complication is rare. In majority of cases, the shunt can be removed uneventfully. In this article, we reported a rare complication of shunt migration resulting in the need of thoracoscopic removal at newborn period. The patient born at 39+3 weeks of gestation suffered from antenatal chylothorax detected at 28 weeks and was managed by intrauterine thoracoamniotic shunt insertion. This was complicated by shunt displacement, which caused respiratory distress after birth requiring ventilatory support and progressive pleural effusion in this patient. To prevent further neonatal compromise, thoracoscopic removal of the retained shunt was done on day 7 of life followed by post-op chest drain insertion. Post-op condition was stable with resolution of respiratory distress, and the patient was discharge on post-op day 16. We would like to remind clinicians about this potential complication of thoracoaminotic shunt, which can pose a potential risk of severe neonatal compromise, and that it can be managed by minimal invasive surgery even in the newborn period.
胸腔羊膜分流术一直被视为产前胸腔积液的一种治疗方法，并发症罕见。在大多数情况下，分流管可以顺利取出。在本文中，我们报告了一例罕见的分流管移位并发症，导致新生儿期需要通过胸腔镜取出。该患者孕39+3周出生，孕28周时被诊断为产前乳糜胸，并接受了宫内胸腔羊膜分流管置入术。术后出现分流管移位并发症，导致出生后呼吸窘迫，需要通气支持，且胸腔积液逐渐增多。为防止新生儿病情进一步恶化，在出生后第7天通过胸腔镜取出残留的分流管，术后置入胸腔引流管。术后病情稳定，呼吸窘迫症状缓解，患者于术后第16天出院。我们想提醒临床医生注意胸腔羊膜分流术的这种潜在并发症，它可能会给新生儿带来严重风险，即使在新生儿期也可以通过微创手术进行处理。
