儿童先天性心脏病术后乳糜胸15例诊疗分析

Clinical analysis of chylothorax in 15 children after surgery for congenital heart disease

目的 总结分析先天性心脏病（先心病）术后乳糜胸产生的原因、治疗和预防的临床经验.方法 对2008年12月～2012年12月先心病术后15例乳糜胸患儿的病史特点、诊断、治疗及随访进行回顾性分析.其中动脉导管未闭结扎术后4例,完全性大动脉转位行调转术后2例,单心室行Glenn术后2例,Fontan术后2例,主动脉缩窄术后2例,主动脉弓离断术后2例,完全肺静脉异位引流（心下型）术后1例;乳糜胸发生在左侧14例,双侧1例.诊断时间为术后1～10 d,平均3d.结果 治愈14例（93.3％）,其中12例（80.0％）经饮食及支持治疗痊愈,治疗时间3～ 15 d,平均8d,无复发.1例经饮食及支持治疗,效果不理想,给予胸腔注入高糖、红霉素,3d后胸腔引流量明显减少,治愈无复发.1例经上述保守治疗无效,行胸导管结扎术,术后无复发.死亡l例,为新生儿大动脉调转术后,因禁食时间较长,并发严重感染,错失手术时机,最终死亡.结论 治疗首选个体化的保守治疗,及时手术治疗可提高患儿生存率,节省住院时间及费用.

Objective To explore the cause, treatment and prevention of ehylothorax after surgery for congenital heart disease （CHD）. Methods A retrospective analysis was made to the c[inical data of 15 children with chylothorax after the surgery for CHD within the period from 2008 to 2012. These children were aged from 7 days to 6 years with the weight from 3.0 kg to 20.0 kg. The ligation of patent ductus arteriosus was performed in 4 cases, complete transposition of great arteries in 2 cases, Glenn operation for a single ventricle in 2 cases,Fontan operation in 2 eases,coarctation of the aorta in 2 eases,operation for interruption of the aortic arch in 2 cases and total pulmonary venous drainage （cardiac lower type）in 1 case. Chylothorax occurred in the left side in 14 cases, bilateral in 1 case. The diagnosis was made at the time from 1 day to 10 days after the surgery with an average of 3 days. Results 14 patients were cured（93.3% ） ： 12 cases（80.0% ）were cured with diet and support therapy,the course lasted from 3 days to 15 days with an average of 8 days, no recurrence;1 case, because of the poor effect of diet and support therapy, was given pleural injection of high-sugar and erythromycin and the chest tube output dropped down obviously 3 days late, no reoccurrence;1 case received thoracic duct ligation as the conservative therapy was ineffective, and no recurrence ; the only one case of death occurred after transposition of great arteries due to a longer time of fasting and severe complicated infection. Conelosions Individualization conservative therapy is the first choice for chylothorax, while timely surgery can raise the survival rate and save the hospitalization time and the cost.