Haniuda M, Nishimura H, Kobayashi O, Yamanda T, Miyazawa M, Aoki T, Iida F
Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
J Am Coll Surg. 1995 May;180(5):537-40.
Conservative management with intrapleural drainage and total parenteral nutrition (TPN) has been the first choice of treatment for postoperative chylothorax. With this approach, however, it usually takes several weeks for the chylothorax to resolve and it is sometimes unsuccessful. In this study, we reviewed seven patients who had chylothorax develop after pulmonary resection for primary carcinoma of the lung.
The patients were treated according to a "one-week trial" that consisted of one week of observation with intrapleural drainage and maximum parenteral nutritional support followed by operative intervention if the effect of the conservative therapy was not adequate. When the chylous leak was decreased to less than 100 mL/day or less than 15 percent of the maximum daily drainage volume after the "one-week trial," the conservative management was continued for two more weeks. After observation for three weeks, oral intake was begun and a final evaluation of the treatment was made.
One patient did not consent to the "one-week trial" and underwent operative treatment on the third postoperative day. Two patients had chylous leaks less than 100 mL/day or less than 15 percent of the maximum daily chylous leak after one week observation. Conservative management with TPN was continued in these patients for two more weeks and operation was performed in one on the 20th day and in the other on the 22nd postoperative day. The remaining four patients underwent operative treatment on the seventh or eighth postoperative day. All of the operations for chylothorax were successful, and chest tubes were removed promptly. These results show that operative management of chylothorax was reliable and safe. The "one-week trial," however, offered few advantages in determining the therapeutic strategy for postoperative chylothorax.
胸腔内引流和全胃肠外营养（TPN）的保守治疗一直是术后乳糜胸的首选治疗方法。然而，采用这种方法，乳糜胸通常需要数周才能消退，而且有时并不成功。在本研究中，我们回顾了7例因原发性肺癌行肺切除术后发生乳糜胸的患者。
患者按照“一周试验”进行治疗，该试验包括一周的胸腔内引流观察和最大程度的胃肠外营养支持，如果保守治疗效果不佳则进行手术干预。当“一周试验”后乳糜漏减少至每日100 mL以下或最大每日引流量的15%以下时，继续保守治疗两周。观察三周后，开始经口进食并对治疗进行最终评估。
1例患者不同意“一周试验”，于术后第3天接受了手术治疗。2例患者在观察一周后乳糜漏每日少于100 mL或少于最大每日乳糜漏量的15%。这些患者继续接受TPN保守治疗两周，其中1例在术后第20天、另1例在术后第22天接受了手术。其余4例患者在术后第7天或第8天接受了手术治疗。所有乳糜胸手术均获成功，胸腔引流管迅速拔除。这些结果表明，乳糜胸手术治疗可靠且安全。然而，“一周试验”在确定术后乳糜胸的治疗策略方面优势不大。
