Department of Thoracic and Cardiovascular Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Ann Palliat Med. 2021 Apr;10(4):4970-4974. doi: 10.21037/apm-21-605.
A 26-year-old female was admitted to the emergency department of thoracic surgery complaining of chest tightness, shortness of breath, and a history of bilateral tuberculosis. A chest Computed Tomography (CT) scan showed bilateral pleural effusion. After that, the patient was implanted with bilateral intercostal drainage tubes. Further analysis of the pleural effusion was conducted to confirm the diagnosis of bilateral chylothorax. We initiated conservative treatment consisting of fasting and total parenteral nutrition. After the failure of conservative treatment, the patient underwent ligation of the thoracic duct by right-sided thoracotomy combined with talc slurry. On the first day postoperatively, the right pleural effusion had decreased significantly, while the left pleural effusion had not. Subsequently, talc slurry was injected into the left thoracic drainage tube of the patient. Bilateral pleural effusion was significantly reduced. Re-examination chest X-ray showed the disappearance of pleural effusion, and the patient was discharged good healthy. Chest X-rays were reexamined one month postoperatively, and the patient's lung was well dilated, with no recurrence of pleural effusion. In this case, it was shown that conservative treatment is the first choice for chylothorax. However, if this proves to be ineffective, early surgical treatment should be considered. Early diagnosis and timely surgical intervention are the key factors to improve the prognosis of patients.
一位 26 岁女性因胸闷、呼吸急促就诊于胸外科急诊，并患有双侧肺结核病史。胸部 CT 扫描显示双侧胸腔积液。随后，患者被植入双侧肋间引流管。进一步对胸腔积液进行分析以确认双侧乳糜胸的诊断。我们开始进行保守治疗，包括禁食和全肠外营养。保守治疗失败后，患者接受右侧开胸胸导管结扎术联合滑石粉浆。术后第一天，右侧胸腔积液明显减少，而左侧胸腔积液没有减少。随后，向患者左侧胸腔引流管注入滑石粉浆。双侧胸腔积液明显减少。复查胸部 X 线片显示胸腔积液消失，患者康复出院。术后 1 个月复查胸部 X 线片，患者肺部扩张良好，无胸腔积液复发。在本例中，表明保守治疗是乳糜胸的首选治疗方法。然而，如果这被证明无效，则应考虑早期手术治疗。早期诊断和及时的手术干预是改善患者预后的关键因素。
