Kostiainen S, Meurala H, Mattila S, Appelqvist P
Scand J Thorac Cardiovasc Surg. 1983;17(1):79-83. doi: 10.3109/14017438309102384.
Clinical experience in nine cases of chylothorax is presented. In five cases the cause was iatrogenic, in two cases idiopathic and in two cases the chylothorax was secondary to an advanced malignant disease. Iatrogenic chylothorax occurred after mediastinoscopy, thoracic sympathectomy, pneumonectomy, resection of an aneurysm of the thoracic aorta and closure of a patent ductus arteriosus. Only one of these patients needed an operative closure of the thoracic duct. In one of the two cases of a neoplastic origin the chylothorax was caused by a malignant mesothelioma and thoracic duct ligation was needed while in the other case it was due to an inoperable pancreatic carcinoma and was treated by thoracocentesis. In one of the idiopathic cases supradiaphragmatic ligation of the thoracic duct was necessary. It is concluded that in most iatrogenic or traumatic cases chylothorax can be cured by conservative therapy (diet, thoracocentesis); in other cases the operative therapy should be adjusted to the primary disease, and the ligation of the thoracic duct should be performed at a level where it is able to prevent the chylous leak without unnecessarily interfering with the collateral lymphatic circulation. Abundant and prolonged chylous leakage should be always treated operatively to prevent disastrous nutritional and immunological deficiencies.
本文介绍了9例乳糜胸的临床经验。其中5例病因是医源性的，2例为特发性，2例乳糜胸继发于晚期恶性疾病。医源性乳糜胸发生于纵隔镜检查、胸交感神经切除术、肺切除术、胸主动脉瘤切除及动脉导管未闭闭合术后。这些患者中只有1例需要手术闭合胸导管。在2例肿瘤源性乳糜胸中，1例由恶性间皮瘤引起，需要进行胸导管结扎，另1例由无法手术切除的胰腺癌引起，采用胸腔穿刺术治疗。在1例特发性病例中，需要在膈上结扎胸导管。结论是，在大多数医源性或创伤性病例中，乳糜胸可通过保守治疗（饮食、胸腔穿刺术）治愈；在其他病例中，手术治疗应根据原发疾病进行调整，胸导管结扎应在能够防止乳糜漏出且不会不必要地干扰侧支淋巴循环的水平进行。大量且持续时间长的乳糜漏应始终进行手术治疗，以防止出现灾难性的营养和免疫缺陷。
