电视胸腔镜术治疗自发性乳糜胸

Video-assisted thoracic surgery in the management of spontaneous chylothorax

目的探讨电视胸腔镜术(VATS)在自发性乳糜胸治疗中的价值.方法2003～2004年间,该院诊治自发性乳糜胸2例,应用电视胸腔镜行膈上胸导管缝扎、胸膜粘连术,术后配合胸膜腔内粘连剂进行治疗.结果1例双侧乳糜胸患者手术时间120min,术后引流19000ml,其中左侧7 200ml,引流27 d,平均270ml/d;右侧11 800ml,引流12 d,平均980ml/d.1例单纯右侧乳糜胸患者手术150min,术后引流5 800ml,引流15 d,平均400ml/d.2例患者胸内均未发现明显肿块及胸导管行程渗漏,且成功控制乳糜胸,伴乳糜性腹水者亦自行消失,术后恢复顺利,无严重并发症;分别随访2个月和7个月,均未见乳糜胸复发,并能正常工作、生活.结论电视胸腔镜下膈上胸导管缝扎、胸膜粘连术,术后配合胸膜腔内粘连剂治疗自发性乳糜胸是安全、有效的治疗方法,值得进一步探讨.

Objective: To explore the value of Video-assisted thoracic surgery in the management of spontaneous chylothorax. Methods: From 2003 to 2004, tow spontaneous chylothorax cases were treated by thoracic duct ligation just above the diaphragm and pleurodesis under VATS by the right thorax in our department,accompanied with chemical glue postoperative. Results: The surgery duration of bilateral spontaneous chylothorax case was 120 minutes. The drainage volume postoperative was 19 000 milliliter. Among those, 11 800 milliliter in the right thorax company with drainage duration was 12 days, the average volume was 980 milliliter per day; and 7 200 milliliter in the left thorax companied with drainage duration was 27 days, the average volume was 270 milliliter per day. Similarly, the surgery duration of the right spontaneous chylothorax case was 150 minutes. The drainage volume postoperative was 5 800 milliliter, companied with drainage duration was 15 days, the average volume was 400 milliliter per day. Any mass and leakage of the thoracic duct can′t be found intrathorax in our tow cases. Both the tow cases recovered, no major complications and recurrence during follow-up 2 and 7 months, respectively. Conclusion: Thoracic duct ligation and pleurodesis under VATS,accompanied with chemical glue postoperative in the treatment of spontaneous chylothorax is safe and effective. Though it should be further evaluated because of the less case reports.