Kagawa Hiroshi, Stringham John, Selzman Craig, Goodwin Matthew, Frye Laura, Raman Sanjeev, Cahill Barbara, Morrell Matthew
Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Department of Surgery, Division of Cardiothoracic Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
Transplant Proc. 2023 Oct;55(8):1981-1983. doi: 10.1016/j.transproceed.2023.08.003. Epub 2023 Aug 31.
Chylothorax is a rare complication after double lung transplantation. We report a case of a 55-year-old man with idiopathic pulmonary fibrosis. He underwent a double lung transplantation with venoarterial extracorporeal membrane support. The surgery was uncomplicated; however, his postoperative course was complicated with a refractory chylothorax that started postoperative day 4. Medical management could not control the chylothorax, including nil per os, total parenteral nutrition, and octreotide administration. After failed percutaneous embolization via lymphangiography and surgical ligation of the thoracic duct and pleurodesis via video-assisted thoracoscopic surgery, percutaneous needle disruption of the retroperitoneal lymph nodes was performed. After this procedure, the chylothorax resolved quickly. Percutaneous needle disruption of the retroperitoneal lymph node is safe and effective for refractory chylothorax. This technique can be one of the main modalities to manage chylothorax after lung transplantation.
乳糜胸是双肺移植术后一种罕见的并发症。我们报告一例55岁特发性肺纤维化男性患者。他接受了静脉-动脉体外膜肺氧合支持下的双肺移植手术。手术过程顺利；然而，术后第4天他出现了难治性乳糜胸，术后病程变得复杂。包括禁食、全胃肠外营养和使用奥曲肽在内的内科治疗均无法控制乳糜胸。经淋巴管造影进行经皮栓塞、胸导管手术结扎及电视辅助胸腔镜手术胸膜固定术均失败后，进行了经皮穿刺破坏腹膜后淋巴结。此操作后，乳糜胸迅速消退。经皮穿刺破坏腹膜后淋巴结治疗难治性乳糜胸安全有效。该技术可成为肺移植术后乳糜胸的主要治疗方式之一。
