Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax
Thoracoscopic direct clipping of the thoracic duct for chylopericardium and chylothorax
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DOI：
10.1016/s0003-4975(00)01921-4
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发表时间：
2000-11-01
影响因子：
4.6
通讯作者：
Wolf, RK
中科院分区：
文献类型：
--
作者：
Wurnig, PN;Hollaus, PH;Wolf, RK
背景乳糜胸是一个具有挑战性的临床问题。未经治疗，它具有很高的死亡率和发病率。保守治疗无效的病例传统的外科治疗方法是经右侧开胸行胸导管结扎术。我们描述了4例成功治疗的视频辅助胸外科手术，使用港口和没有开胸，精确结扎和分裂的胸导管就在隔膜上方。与终末期肾病患者一样，在乳糜心包患者中制作心包窗。对食管癌患者和颈静脉、锁骨下静脉血栓形成患者行胸膜固定术。有2名妇女，年龄分别为18岁和42岁，2名男子，年龄分别为61岁和65岁。未发生手术相关死亡或发病。在患者1、2、3和4中，术后引流持续时间分别为5、7、7和5天（平均持续时间为6天），住院时间分别为5、9、10和5天（平均住院时间为7天）。在随访期间（范围，2至24个月;平均随访，9个月）没有乳糜胸或乳糜心包复发。1例术后4个月死于食管癌。无开胸的电视胸腔镜手术是治疗乳糜胸的有效方法，发病率最低。(Ann Thorac Surg 2000;70：1662-5）（C）2000年，胸外科医师协会。
Background. Chylothorax is a challenging clinical problem. Untreated, it carries a high mortality and morbidity. Traditional surgical management for cases refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy.Methods. We describe 4 patients treated successfully by video-assisted thoracic surgery, using ports and no thoracotomy, and precise ligation and division of the thoracic duct just above the diaphragm. A pericardial window was made in the patient with chylopericardium, as in the patient with end-stage renal disease. Pleurodesis was used in the patient with esophageal carcinoma and the patient with jugular and subclavian vein thrombosis.Results. There were 2 women aged 18 and 42 years and 2 men, aged 61 and 65 years. No procedure-related mortality or morbidity occurred. In patients 1, 2, 3, and 4, the postoperative duration of drainage was 5, 7, 7, and 5 days, respectively (mean duration, 6 days) and the hospital stay, 5, 9, 10, and 5 days, respectively (mean stay, 7 days). There was no recurrence of chylothorax or chylopericardium during follow-up (range, 2 to 24 months; mean follow-up, 9 months). One patient died of esophageal carcinoma 4 months after operation.Conclusions. Video-assisted thoracic surgery without a thoracotomy is an effective way of treating chylothorax and carries minimal morbidity. (Ann Thorac Surg 2000;70:1662-5) (C) 2000 by The Society of Thoracic Surgeons.