Zhang Kejian, Li Changyuan, Zhang Mingrui, Li Yang
Department of Thoracic Surgery, Jilin Cancer Hospital, Chang Chun, Jilin, 130021, People's Republic of China.
Department of Thoracic Surgery, First Hospital of Jilin University, Xinmin street 71, Chang Chun, 130021, People's Republic of China.
J Cardiothorac Surg. 2021 May 28;16(1):149. doi: 10.1186/s13019-021-01462-6.
To retrospectively assess the efficacy of hypertonic glucose pleurodesis for treatment of chylothorax after pulmonary resection.
Out of a total of 8252 patients who underwent pulmonary resection (at least lobectomy) at department of thoracic surgery, between June 2008 and December 2015, 58 patients (0.7%) developed postoperative chylothorax. All patients received conservative treatment, including thoracic closed drainage, oral fasting, and total parenteral nutrition.
Conservative treatment was successful in 50 (86.2%) patients, while eight patients [mean age: 58.0 years (range, 45-75)] were treated with hypertonic glucose pleurodesis. All eight patients had undergone operation for lung cancer (four squamous cell carcinomas and four adenocarcinomas). The bronchial stump was covered by pleural flap in three patients. After pleurodesis, three patients developed fever but without empyema; thoracentesis was performed in two patients. The mean time interval between pleurodesis and operation was 4.3 days (range,3-5) days. The average length of stay was 23.1 days (range, 18-31). No recurrent pleural effusion was observed over a mean follow-up duration of 28 months.
Hypertonic glucose pleurodesis performed via the chest drainage tube is a viable treatment option for chylothorax after lung resection, prior to resorting to a thoracoscopic or thoracotomic ductus thoracicus ligation of the thoracic duct leak. It is a simple, safe and efficient modality associated with rapid recovery and less pain.
回顾性评估高渗葡萄糖胸膜固定术治疗肺切除术后乳糜胸的疗效。
2008年6月至2015年12月期间，在胸外科接受肺切除术（至少肺叶切除术）的8252例患者中，58例（0.7%）发生术后乳糜胸。所有患者均接受保守治疗，包括胸腔闭式引流、禁食和全胃肠外营养。
50例（86.2%）患者保守治疗成功，8例患者[平均年龄：58.0岁（范围45 - 75岁）]接受高渗葡萄糖胸膜固定术治疗。所有8例患者均因肺癌接受手术（4例鳞状细胞癌和4例腺癌）。3例患者支气管残端由胸膜瓣覆盖。胸膜固定术后，3例患者出现发热但无脓胸；2例患者进行了胸腔穿刺。胸膜固定术与手术之间的平均时间间隔为4.3天（范围3 - 5天）。平均住院时间为23.1天（范围18 - 31天）。平均随访28个月未观察到复发性胸腔积液。
在采取胸腔镜或开胸胸导管结扎胸导管漏之前，经胸腔引流管进行高渗葡萄糖胸膜固定术是肺切除术后乳糜胸的一种可行治疗选择。它是一种简单、安全且有效的方式，恢复快且疼痛轻。
