Fukaya Takumi, Kasai Hajime, Saito Mikihito, Sasatani Yuika, Urushibara Takashi, Sakao Seiichiro
Department of Medicine, School of Medicine, Chiba University, Chiba, 260-8670, Japan.
Department of Respiratory Medicine, Kimitsu Chuo Hospital, Kisarazu, 292-8535, Japan.
Respir Med Case Rep. 2021 Jun 12;33:101448. doi: 10.1016/j.rmcr.2021.101448. eCollection 2021.
Yellow nail syndrome (YNS) is a rare condition characterized by the triad of yellow nails, lymphedema, and respiratory manifestations. Diuretics and thoracic drainage are often not effective in YNS, and the most effective treatments are pleurodesis and decortication/pleurectomy. A 66-year-old man was admitted to our hospital for YNS after esophagectomy with gastric tube reconstruction for esophageal cancer. The patient presented with yellow nails and lymphedema. Chest X-rays and computed tomography showed massive pleural effusions and ascites that were both chylous. The patient was considered to have YNS that became apparent after surgery. He recovered with diuretics and a low-fat diet without pleurodesis and decortication/pleurectomy. Thoracic surgery can exacerbate the functional impairment of lymphatic drainage in patients with asymptomatic and undiagnosed YNS, and can lead to further development of YNS-related clinical symptoms. Despite relatively massive chylothorax following thoracic surgery, chylothorax related to YNS could be successfully controlled with conservative treatment without pleurodesis and decortication/pleurectomy.
黄甲综合征（YNS）是一种罕见疾病，其特征为黄甲、淋巴水肿和呼吸系统表现三联征。利尿剂和胸腔引流对YNS通常无效，最有效的治疗方法是胸膜固定术和去皮质术/胸膜切除术。一名66岁男性因食管癌行食管切除加胃管重建术后因YNS入住我院。患者出现黄甲和淋巴水肿。胸部X线和计算机断层扫描显示大量乳糜性胸腔积液和腹水。该患者被认为在手术后出现了明显的YNS。他通过利尿剂和低脂饮食康复，未进行胸膜固定术和去皮质术/胸膜切除术。胸外科手术可加重无症状且未确诊的YNS患者淋巴引流的功能损害，并可导致YNS相关临床症状进一步发展。尽管胸外科手术后出现了相对大量的乳糜胸，但与YNS相关的乳糜胸可通过保守治疗成功控制，无需进行胸膜固定术和去皮质术/胸膜切除术。
