Department of Breast and Thyroid Department, Women and Children's Hospital of Chongqing Medical University: Chongqing Health Center for Women and Children, Chongqing, China.
Intelligent Integrated Circuits and Systems Laboratory (SICS Lab), University of Electronic Science and Technology of China, Chengdu, China.
Medicine (Baltimore). 2024 Nov 8;103(45):e40371. doi: 10.1097/MD.0000000000040371.
This case analysis and literature review aim to identify the causes of bilateral chylothorax following thyroid cancer surgery, a rare yet serious complication.
We report 2 East Asian women who developed bilateral chylothorax after undergoing total thyroidectomy with neck lymph node dissection. Both patients presented with dyspnea and significant pleural effusion postoperatively.
Both patients were diagnosed with bilateral chylothorax based on clinical examination and imaging studies, including chest ultrasonography and X-rays.
In both cases, conservative management was initially implemented, involving chest tube drainage, total parenteral nutrition, and octreotide therapy. Surgical intervention was considered if conservative measures failed to control the chylous output.
Both patients showed gradual improvement with conservative treatment, ultimately resulting in successful resolution of pleural effusion and discharge from the hospital without complications.
For patients with bilateral chylothorax, conservative treatment should be the initial approach for small effusions. For moderate to large effusions, placement of a chest drainage tube is recommended, and surgical intervention should be considered if chyle volume exceeds 10 mL/(kg/d) for 48 to 72 hours or persists for more than 11 days following conservative treatment.
本病例分析及文献复习旨在明确甲状腺癌术后双侧乳糜胸的病因，这是一种罕见但严重的并发症。
我们报告了 2 例东亚女性，她们在接受甲状腺全切除术及颈部淋巴结清扫术后发生双侧乳糜胸。2 例患者术后均出现呼吸困难和明显胸腔积液。
根据临床检查和影像学研究，包括胸部超声和 X 线，均诊断为双侧乳糜胸。
最初均采用保守治疗，包括胸腔引流管、全胃肠外营养和奥曲肽治疗。如果保守治疗未能控制乳糜液排出，则考虑手术干预。
2 例患者均经保守治疗逐渐好转，最终胸腔积液成功消退，患者无并发症出院。
对于双侧乳糜胸患者，如果胸腔积液较小，应首先采用保守治疗。对于中至大量胸腔积液，建议放置胸腔引流管。如果在保守治疗后 48-72 小时内乳糜液量超过 10 mL/（kg/d）或持续超过 11 天，或持续存在，应考虑手术干预。
