ObjectiveTo investigate the caring method for neonatal chylothorax. MethodsWe retrospectively analyzed the clinical data of four hospitalized patients admitted from December 2011 to February 2013. ResultsThe treatment course lasted from 7 to 43 days, averaging 25 days. Three patients were cured and discharged from the hospital; one patient with ineffective outcome by conservative treatment was turned into surgical operation. ConclusionIn order to facilitate the recovery of the neonates suffering from neonatal chylothorax, it is important for us to ensure appropriate dietary management, total parental nutrition support, observation and care of closed drainage tube of thoracic cavity, accurate medication, safe intravenous fluids access and infection control.
ObjectiveTo investigate the clinical characteristics, diagnosis and management of postoperative chylothorax after congenital cardiac surgery in infants and children. MethodsWe retrospectively analyzed clinical data of 79 postoperative patients with chylothorax after congenital cardiac surgery in Guangdong General Hospital between January 2006 and December 2013.There were 54 males and 25 females at age ranged 8 days to 14 years. ResultsThe prevalence of postoperative chylothorax was 0.6% (79/12 067). A total of 75 (94.9%) patients were cured. And 71 patients (89.9%) were cured by conservative treatment. While 4(5.1%) patients received operative treatment, including 3 patients undergoing ligation of thoracic duct, 1 patient undergoing lymphatic ablation. There were 4 (5.1%) patients failed to treat, including 1(1.3%) abandoned, 3 (mortality of 3.8%) deaths in hospital for low cardiac output syndrome, cardiac arrest and severe anastomotic stenosis after transposition of conducting arteries(TGA), tetralogy of Fallot(TOF) and total anomalous pulmonary venous connection(TAPVC) operation respectively. Hospitalization time ranged 10 to 108 (39.3±19.4) d. There was no recurrence of chylothorax within 6 months to 8 years of following-up. ConclusionThe key to prevention of chylothorax is to improve the surgical technology. Conservative management of chylothorax will be successful in most cases, but surgical treatment ought to be considered if the conservative management is unsuccessful.
ObjectiveTo study the effect of preoperative oral administration of olive oil in the patients with laparoscopic resection of esophageal carcinoma and to expose the advantages of alimentary duct in operation. MethodsWe retrospectively analyzed the clinical data of 136 patients in our hospital from June 2013 through June 2015 year. There were 83 males and 53 females at age of 58.3±7.6 years. The patients were given oral olive oil 100 ml at preoperative 12 hours. ResultsAll patients completed surgery successfully without transfer to open chest. Operation of thoracic duct filling was transparent, milky white, and with clear exposure. Thoracic duct was retained successfully in the 131 patients. It was found that intraoperative injury during separation of thoracic duct due to tumor invasion in 5 patients. These patients were treated with by titanium clipping. All the patients were with chest tube drainage for 3-5 d. Average drainage volume at postoperative 24 hours was 150±35 ml. Postoperative total drainage volume was 500±130 ml. None of postoperative chylothorax was found. Postoperative average hospitalization time was 9±2 d. ConclusionEsophageal cancer preoperative oral administration of olive oil is simple, safe, effective, no injury, and with clear exposure in thoracic duct in operation. Injury of the thoracic duct is reduced. The integrity of thoracic duct is preserved. Normal glucose and lipid metabolism is retained. Therefore, it is a good choice in preoperative preparation for esophageal cancer patients. It is worth popularization and application.
ObjectivesTo compare the clinical efficacy of different surgical thoracic duct management on prevention of postoperative chylothorax and its impact on the outcome of the patients. MethodsWe searched the electronic databases including PubMed, The Cochrane Library (Issue 4, 2016), Web of Science, CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs), cohort studies and case-control studies related to the comparison of different surgical thoracic duct management during esophagectomy on prevention of postoperative chylothorax from inception to May 2016. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then RevMan 5.2 software was used for meta-analysis. ResultsTwenty-three trials were included, involving four RCTs, four cohort studies and 15 case-control studies. The results of meta-analysis indicated:(1) Prophylactic thoracic duct ligation group had lower incidence of postoperative chylothorax compared with non thoracoic duct ligation group (RCT:OR=0.20, 95%CI 0.09 to 0.47, P=0.000 02; Co/CC:OR=0.20, 95%CI 0.14 to 0.28, P<0.000 01); (2) There were no significant differences between the two groups in the respect of mortality, morbidity and the 2-year, 3-year, 5-year survival rates (all P values >0.05); (3) Prophylactic thoracic duct ligation could reduce the reoperation rate of chylothorax complicating esophageal cancer patients (RCT:OR=0.17, 95%CI 0.10 to 0.28, P<0.000 01; Co/CC:OR=0.18, 95%CI to 0.11 to 0.32, P<0.000 01), and increase the cure rate of expectant treatment on them (OR=0.25, 95%CI 0.11 to 0.56, P=0.000 8); (4) En bloc thoracic duct ligation group had a lower incidence of postoperative chylothorax compared with single thoracic duct ligation group (OR=3.67, 95%CI 1.43 to 9.43, P=0.007). ConclusionProphylactic thoracic duct ligation during esophagectomy could effectively reduce the incidence of postoperative chylothorax and is good for reducing the reoperation rate of chylothorax complicating esophageal cancer patients. En bloc thoracic duct ligation has a better efficacy on prevention of postoperative chylothorax compared with single thoracic duct ligation.
ObjectiveTo review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.MethodsA total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2012 to January 2020 were continuously collected. According to the inclusion and exclusion criteria, 37 patients were finally included. There were 20 males and 17 females with an average age of 55.55±10.49 years. Chylothorax was diagnosed primarily by triglyceride levels (above 110 mg/dL) or the Sudan triple stain test. Treatment included surgical and non-surgical treatment. The overall incidence, high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed. According to the treatment methods, the patients were divided into a surgical treatment group and a non-surgical treatment group. The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.ResultsIncluded patients accounted for 0.3% (37/12 515) of lung cancer thoracoscopic surgery in our hospital during the same period. The incidence of postoperative chylothorax in patients with right lung surgery (0.2%, 29/12 515) was higher than that of patients with left lung surgery (0.1%, 8/12 515). Of 37 patients with chylothorax after lung cancer surgery, 32 patients were in the non-surgical treatment group (86.5%, 32/37), and the rate was higher compared with the surgical treatment group (13.5%, 5/37, P=0.000). The average daily drainage in the surgical treatment group was 777 mL more than that in the non-surgical treatment group (95%CI 588.58 to 965.55, P<0.001). The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group (8 609.2±4 680.3 mL vs. 4 911.2±3 925.5 mL, P=0.055). The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment group (P=0.162, P=0.118). The tube indwelling time (8.2±2.7 d) was shorter than that of the non-surgical treatment group (12.3±6.8 d, P=0.204).ConclusionThe treatment of chylothorax after radical resection of VATS lung cancer is still mainly non-surgical treatment. Surgical treatment should be initiated as early as possible when the drainage volume is too large 72 hours after chylothorax surgery after radical resection of VATS lung cancer.