Lovati Eleonora, Ruggiero Ciro, Masciale Valentina, Stefani Alessandro, Morandi Uliano, Aramini Beatrice
Division of Thoracic Surgery, Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy.
Int J Surg Case Rep. 2021 Feb;79:156-159. doi: 10.1016/j.ijscr.2021.01.018. Epub 2021 Jan 15.
Chylothorax is an uncommon form of pleural effusion characterized by the presence of chylomicrons, triglycerides and cholesterol in the physical and chemical examination of the pleural fluid. It may have poor prognosis if not properly treated. Currently, conservative measures are the first line of treatment for managing chylothorax. The aim of our study is to show and suggest the use of octreotide in association with talc poudrage as good option to manage post-operative a severe chylothorax.
A 59-year-old male patient who underwent a replacement of the ascending aorta, aortic hemiarch and surgery of the aortic valve for aortic dissection showed a severe pleural effusion three months after surgery. Because the physical and chemical examination of the pleural fluid revealed high levels of triglycerides and cholesterol, a conservative treatment with pleural drainage, TPN and nihil per os was attempted, with the introduction of 0.3 mg/die of octreotide on day thirty-four. With the application of talc poudrage, the chylothorax completely resolved.
Octreotide has been shown to significantly decrease chylous effusion in many studies, but the dose and duration of therapy have not yet been defined. Our patient responded partially to octreotide after two days of treatment, with the drainage leak reduced to less than 100 mL/day.
After octreotide treatment associated with talc poudrage, the drainage leak was drastically reduced, suggesting that this could be a useful approach in the management of severe chylous leaks.
乳糜胸是一种罕见的胸腔积液形式，其特征在于胸腔积液的物理和化学检查中存在乳糜微粒、甘油三酯和胆固醇。若治疗不当，预后可能较差。目前，保守措施是治疗乳糜胸的一线方法。我们研究的目的是展示并建议将奥曲肽与滑石粉喷洒联合使用，作为治疗术后严重乳糜胸的良好选择。
一名59岁男性患者因主动脉夹层接受升主动脉置换、主动脉半弓置换及主动脉瓣手术，术后三个月出现严重胸腔积液。由于胸腔积液的物理和化学检查显示甘油三酯和胆固醇水平较高，尝试采用胸腔引流、全胃肠外营养和禁食的保守治疗，并在第34天开始使用0.3毫克/天的奥曲肽。通过应用滑石粉喷洒，乳糜胸完全消退。
许多研究表明奥曲肽可显著减少乳糜性积液，但治疗的剂量和持续时间尚未确定。我们的患者在治疗两天后对奥曲肽部分有反应，引流液漏出量减少至每天小于100毫升。
奥曲肽治疗联合滑石粉喷洒后，引流液漏出量大幅减少，表明这可能是治疗严重乳糜漏的一种有效方法。
