Long Weiguang, Cai Bin, Liu Yang, Zheng Shaoyi, Luo Juan
Lymphatic Surgery Department, The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China.
J Thorac Dis. 2024 Dec 31;16(12):8743-8753. doi: 10.21037/jtd-2024-2111. Epub 2024 Dec 27.
Chylopericardium is a rare disease resulting from lymphatic system dysfunction and characterized by recurrent chylous pericardial effusion and cardiac compression. Traditional treatments like fasting, somatostatin injection and ligation of pericardial lymphatic vessels are less effective, with high recurrence rate. Fenestration is regarded as the last resort for treating chylopericardium. Our team designed a novel minimally invasive pericardial fenestration surgical technique (LONG procedure) for the treatment of chylopericardium. This study assessed its efficacy and technical characteristics, with the aim of providing valuable insights into the surgical treatment and management of chylopericardium.
The clinical data of 7 patients with chylopericardium treated by the LONG procedure in the lymphatic surgery department from January 2018 to June 2024 were retrospectively analyzed. The data included the patients' medical history, imaging examination, pericardial effusion analysis, operative details, drainage output, length of hospital stay, and follow-up results. The indicators were analyzed to assess the technical characteristics of the LONG procedure.
Seven male patients aged between 7 and 35 years were enrolled in this study. The duration of the disease course ranged from 3 months to 10 years. All patients had previously accepted pericardial drainage, a fat-free diet, and anti-infection treatments. Some patients had also undergone thoracic duct adhesiolysis, embolization, or lymphatic ligation; however, they experienced recurrent pericardial effusion. Upon admission, all patients presented with at least moderate volumes of pericardial effusion. The LONG procedure was successfully performed on all patients, with an operation time of 54 to 95 minutes and minimal intraoperative blood loss (1-5 mL). Chest tubes were removed once the drainage became clear, typically between 15 to 37 days postoperation. Patients were discharged after 1-2 weeks of observation, with no recurrence or complications observed during the follow-up period of up to 5 years.
The LONG procedure seems to be effective for the treatment of chylopericardium with low postoperative recurrence rates, but more research and long-term observation are needed.
乳糜性心包炎是一种因淋巴系统功能障碍导致的罕见疾病，其特征为反复发作的乳糜性心包积液和心脏受压。禁食、注射生长抑素及心包淋巴管结扎等传统治疗方法效果欠佳，复发率高。开窗术被视为治疗乳糜性心包炎的最后手段。我们团队设计了一种新型微创心包开窗手术技术（LONG术式）用于治疗乳糜性心包炎。本研究评估了其疗效和技术特点，旨在为乳糜性心包炎的外科治疗和管理提供有价值的见解。
回顾性分析2018年1月至2024年6月在淋巴外科接受LONG术式治疗的7例乳糜性心包炎患者的临床资料。数据包括患者病史、影像学检查、心包积液分析、手术细节、引流量、住院时间及随访结果。对这些指标进行分析以评估LONG术式的技术特点。
本研究纳入7例年龄在7至35岁之间的男性患者。病程持续时间为3个月至10年。所有患者此前均接受过心包引流、无脂饮食及抗感染治疗。部分患者还接受过胸导管粘连松解术、栓塞术或淋巴管结扎术；然而，他们仍出现复发性心包积液。入院时，所有患者均至少有中等量的心包积液。所有患者均成功实施了LONG术式，手术时间为54至95分钟，术中出血量极少（1 - 5毫升）。一旦引流液变清，通常在术后15至37天拔除胸腔引流管。患者在观察1 - 2周后出院，在长达5年 的随访期内未观察到复发或并发症。
LONG术式似乎对治疗乳糜性心包炎有效且术后复发率低，但仍需要更多研究和长期观察。
