生长抑素在儿童先天性心脏病术后乳糜胸保守治疗中的应用

Application of somatostatin in expectant treatment for postoperative chylothorax in children after congenital heart disease surgery

目的研究生长抑素在儿童先天性心脏病术后乳糜胸保守治疗中的临床疗效。方法回顾性分析2003年1月至2012年12月武汉市儿童医院收治的先天性心脏病术后并发乳糜胸的13例患儿临床资料，2009年前采用常规治疗（对照组，6例），2009年后采用生长抑素治疗（治疗组，7例），2组患儿年龄、体质量、术后发生乳糜胸时间等一般资料比较，差异均无统计学意义，乳糜胸诊断标准一致。分析比较2组病例治疗前、治疗中乳糜胸引量变化、治愈时间等指标。结果对照组6例乳糜胸患儿中3例经保守治疗临床治愈，3例保守治疗无效（2例手术治疗痊愈，1例死亡）。对照组乳糜胸引量在治疗后1周[（155．5±85．7）mL／d]及2周[（142．3±110．3）mL／d]较治疗前[（256．6±124．2）mL／d]减少（t=4．623、2．099，P=0．002、0．044）。对照组乳糜胸引量治疗3周后[（139．4±113．4）mL／d]较治疗前无明显减少（t=1．745，P=0．07）。治疗组6例保守治疗成功，1例手术后痊愈。治疗组乳糜胸引量在治疗后1周[（51．2±18．7）mL／d]及2周[（19．3±7．05）mL／d]较治疗前[（300．3±115．6）mL／d]明显减少（t=5．549、6．638，P=0．001、0．001）。2组胸引革在治疗后1周、2周比较差异均有统计学意义（t=2．900、2．412，P=0．014、0．034）。2组保守治愈病例术后痊愈时间[（32．8±1．8）d比（25．2±1．7）d]差异有统计学意义（t=2．512，P：0．028）。结论生长抑素能促进婴幼儿术后乳糜胸恢复，在早期保守治疗中应积极使用。

Objective To investigate the therapeutic efficacy of somatostatin on chylothorax after congenital heart disease surgery in children. Methods Retrospective analysis was pertormed in 13 postoperative chylothorax cases from Jan. 2003 to Dec. 2012, who were divided into control group （n = 6 ） and treatment group （n = 7 ） , and there was no significant difference in age, weight, and time of occurrence between the 2 groups. The diagnosis standard for chylo- thorax was the same. The changes of chylous volume during the treatment were analyzed between 2 groups, and healing time and other data were analyzed too. Results Control group：clinical cure in 3 cases,conservative treatment failed in 3 cases（2 cases recovered after operation and 1 case died）. The chyle volume of control group reduced obviously com- pared with post treatment from beginning [ （256.6 ± 124.2） mL/d ] to 1 week [ （ 155.5 ± 85.7 ） mL/d ] and 2 weeks [ （ 142.3 ± 110.3） mL/d] later（ t =4. 623,2. 099;P =0. 002,0. 044）. But it did not reduce obviously in 3 weeks later [ （ 139.4 ± 113.4 ） mL/d ] （ t = 1. 745,P = 0.07 ）. Treatment group ： 6 cases in treatment group were successful in recovery after conservative treatment and 1 case underwent operation. The chyle volume of treatment group reduced obviously compared with post treatment from beginning to 1 week [ （51.2 ± 18.7） mL/dl and 2 weeks [ （ 19.3 ± 7.05 ） mL/d I later （ t = 5. 549,6. 638 ;P = 0. 001,0. 001 ）. Compared with the control group, the difference between 2 groups in post treatment（ 1 week later,2 weeks later） was of statistical significance（t = 2. 900,2. 412;P =0. 014, 0. 034）. The healing time of conservative treatment in 2 groups （ only for recovery） had obvious difference [ （ 32.8 ± 1.8 ） d, （25.2 ± 1.7 ） d] （ t= 2.512,P = 0. 028 ）. Conclusions The use of somatostatin can significantly promote the recovery of chylothorax in children,and it should be actively used in early conservative treatment.