- 期刊
Postoperative Chylothorax Subsequent to Cardiac Surgery
心臟外科手術後乳糜胸
摘要
目的：本文旨在描述心臟外科手術後乳糜胸的特徵，並進一步檢討其治療策略。 方法：搜集1966年至今的美國國立醫學圖書館 Index Medicus/MEDLINE 數據庫的心臟外科手術後乳糜胸的文獻，共檢得61篇文獻198病例。其中包括28篇文獻中的161例（81.31%） 先天性心臟病，22 篇文獻中的24例（12.12%） 冠狀動脈繞道手術，3篇文獻中的5例（2.53%） 瓣膜置換術，4篇文獻中的4例（2.02%） 主動脈瘤手術，4篇文獻中的4例（2.02%）心臟移植手術。 結果：就先天性心臟病的手術種類而言，術後乳糜胸最多發生在主動脈弓中斷手術（15.70%），其次為開放性動脈導管的结紮手術（10.47%）、Fallot四聯症根治術（8.72%）、 Mustard procedure（7.56%）、modified Fontan procedure（7.56%）以及 Blalock shunt（6.98%）。64例記錄了治療方法，其中41例（64.06%）採取保守治療，23例（35.94%）採取外科治療。兩種治療措施的治愈率為97.47%。5例死亡，死亡率為 2.53%，其中4例（80%）死因與乳糜胸無關。 結論：乳糜胸是心臟外科手術後少見的併發症。診斷主要依賴胸液的檢查。一旦確診，首先應給予營養支持。包括胸腔引流和飲食控制的保守治療2周無效，應採取外科治療。
並列摘要
Objectives: The purpose of this paper is to describe the features of postoperative chylothorax subsequent to cardiac surgery and further discuss the management strategies. Methods: Reports of postoperative chylothorax after cardiac surgery were collected from the Index Medicus/MEDLINE database of the U.S. National Library of Medicine from 1966 to the present. In all, 198 cases of postoperative chylothorax following cardiac surgery were collected from 61 reports, and included 161 cases (81.31%) of congenital heart defect operations from 28 reports, 24 coronary bypasses (12.12%) from 22, 5 heart valve replacements (2.53%) from 3, 4 aortic aneurysm surgeries (2.02%) from 4, and 4 heart transplantations (2.02%) from 4 reports. Results: Postoperative chylothorax occurred most often in the correction of coarctation of the aorta (15.70%), more often in patent ductus arteriosus ligation (10.47%), the tetralogy of Fallot correction (8.72%), the Mustard procedure (7.56%), modified Fontan procedure (7.56%), and Blalock shunt (6.98%), in reference to the types of operation for congenital heart defects. As for the 64 cases whose management strategies were recorded, conservative regimens were applied in 41 patients (64.06%), and surgical intervention in 23 (35.94%). Patients recovered due to either medical or surgical treatment with a curative rate of 97.47%. Five patients died with a mortality of 2.53%, and 4 (80%) of these deaths were clearly identified to be unrelated to chylothorax. Conclusions: Chylothorax is an uncommon complication after cardiac surgery. The diagnosis is mainly based on an examination of the pleural fluid. Once chylothorax is identified, nutritional support is the priority. Surgical treatment is recommanded after a 2-week trial of conservative therapy with chest drainage and diet modulation.