Browse N L, Allen D R, Wilson N M
Department of Surgery, St. Thomas' Hospital, London, UK.
Br J Surg. 1997 Dec;84(12):1711-6.
Chylothorax is a rare primary or secondary condition the optimum management of which remains uncertain.
Twenty cases of chylothorax, including ten of primary chylothorax and ten secondary to either malignancy, subclavian vein thrombosis or lymphangioma treated between 1956 and 1986 have been reviewed.
Open pleurectomy was the most successful treatment in preventing reaccumulation of the effusion. Three patients had thoracic duct-azygous vein anastomoses, but all anastomoses were probably occluded within a year of surgery. Three patients have been lost to follow-up and five died within 2 years of their treatment, but 12 patients were alive and free from an effusion 3-22 years after treatment.
Patients with chylothorax should undergo lymphangiography to identify the cause and site of the lymphatic abnormality. Conservative treatment is successful in some patients but should be abandoned if the fluid loss exceeds 1.5 l/day for more than 5-7 days in an adult or more than 100 ml/day in a child. Parietal pleurectomy is the most successful treatment when no distinct chylous leak can be identified. Less commonly, an isolated chylous leak either in the chest or in the abdomen may be identified and this should be treated by direct ligation.
乳糜胸是一种罕见的原发性或继发性疾病，其最佳治疗方法仍不确定。
回顾了1956年至1986年间治疗的20例乳糜胸病例，其中原发性乳糜胸10例，继发于恶性肿瘤、锁骨下静脉血栓形成或淋巴管瘤的10例。
开放性胸膜切除术是预防积液再次积聚最成功的治疗方法。3例患者进行了胸导管-奇静脉吻合术，但所有吻合术可能在术后1年内闭塞。3例患者失访，5例在治疗后2年内死亡，但12例患者在治疗后3至22年存活且无积液。
乳糜胸患者应进行淋巴管造影以确定淋巴异常的原因和部位。保守治疗在一些患者中是成功的，但如果成人每日液体丢失超过1.5升持续5至7天以上或儿童每日超过100毫升，则应放弃。当无法确定明显的乳糜漏时，壁层胸膜切除术是最成功的治疗方法。较少见的情况是，可能会发现胸部或腹部孤立的乳糜漏，应通过直接结扎进行治疗。
