Plastic bronchitis: Is thoracic duct ligation a real surgical option?
Plastic bronchitis: Is thoracic duct ligation a real surgical option?
复制标题
DOI：
10.1016/j.athoracsur.2005.07.004
复制
发表时间：
2006-06-01
影响因子：
4.6
通讯作者：
Christian, Karla G.
中科院分区：
文献类型：
--
作者：
Salman, S.;Shah, A.;Christian, Karla G.
可塑性支气管炎是一种不寻常的临床情况不明原因，发生在多个临床设置。这种疾病的特点是发展树枝状，厚，顽强管型的气管支气管树，导致气道阻塞。患有先天性心脏病的患者谁经历了丰唐手术是在高风险有这个问题的发展。这种痛苦的情况很难管理，只有姑息性的选择，如反复支气管镜检查，吸入肝素，组织纤溶酶原激活剂，吸入支气管扩张剂，或阿奇霉素。Fontan回路的患者会出现无数独特的并发症，如房性心律失常、复发性胸腔积液、乳糜胸、蛋白丢失性肠病和可塑性支气管炎。胸内淋巴管压力高和淋巴支气管瘘被认为是可塑性支气管炎复发性支气管管型的原因。2例Fontan患者在心导管检查时Fontan压力正常，但其复发性可塑性支气管炎对药物治疗抵抗，我们决定通过进行胸导管结扎来探索手术解决方案。这导致两名患者的管型形成完全消退，他们出院回家，并在继续随访时保持无症状。胸导管结扎术通过降低胸内淋巴管压力和流量，为整形性支气管炎提供了一种外科治疗方法。
Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lymphobronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.