Amate Neto André, de Moraes Amanda Tollini, Preto Felipe Ramos Camargo, Salomão Sarah Lopes, de Nadai Tales Rubens
Department of Thoracic Surgery, Bauru Medical School, University of São Paulo, Bauru, BRA.
Department of Medicine, Bauru Medical School, University of São Paulo, Bauru, BRA.
Cureus. 2024 Sep 19;16(9):e69726. doi: 10.7759/cureus.69726. eCollection 2024 Sep.
Chylothorax, despite being a common complication after thoracic surgery, is rare after thoracic sympathectomy, especially on the right side of the thorax. We present a case of a patient who developed a right chylothorax after a thoracoscopic sympathectomy due to the presence of an anomalous thoracic duct located on the right side of the patient's chest. A 37-year-old woman underwent a bilateral video-assisted thoracic sympathectomy for the treatment of primary focal axillary hyperhidrosis. During the postoperative period, there was an excessive discharge of a white, milky fluid through the chest drain, with an average daily output of 350-500 mL/day. Chylothorax was confirmed after laboratory analysis, which revealed a triglyceride level of 146 mg/dL. Due to the worsening appearance of the pleural fluid and the increased drainage volume, reaching 1,000 mL, the patient underwent exploratory videothoracoscopy. During the procedure, a lymphatic fistula was visualized in the region of the sympathetic chain, allowing the identification of an anomalous thoracic duct on the right side of the patient's thorax. The anomalous thoracic duct was dissected, with inferior and superior clipping of the duct. The patient remained stable and was discharged three days after the procedure. This case report describes an especially rare presentation, being one of the few cases of right chylothorax after thoracoscopic sympathectomy described in the literature to date. This study points out that, despite thoracic sympathectomy being considered a safe surgical procedure, unusual complications, such as chylothorax, and anatomical variations of the thoracic duct must be considered.
乳糜胸虽是胸外科手术后的常见并发症，但在胸交感神经切除术后却较为罕见，尤其是在右侧胸部。我们报告一例患者，该患者因右侧胸部存在异常胸导管，在胸腔镜交感神经切除术后发生了右侧乳糜胸。一名37岁女性因原发性局灶性腋窝多汗症接受了双侧电视辅助胸腔交感神经切除术。术后期间，胸腔引流管有大量白色乳状液体流出，平均每日引流量为350 - 500毫升/天。实验室分析证实为乳糜胸，甘油三酯水平为146毫克/分升。由于胸水外观恶化且引流量增加至1000毫升，患者接受了电视胸腔镜探查术。术中，在交感神经链区域可见淋巴管瘘，从而确定患者右侧胸部存在异常胸导管。对异常胸导管进行了分离，并对导管上下两端进行了夹闭。患者情况稳定，术后三天出院。本病例报告描述了一种极为罕见的情况，是迄今为止文献中描述的胸腔镜交感神经切除术后少数几例右侧乳糜胸病例之一。本研究指出，尽管胸交感神经切除术被认为是一种安全的外科手术，但仍必须考虑到诸如乳糜胸等不寻常并发症以及胸导管的解剖变异情况。
