先天性心脏病术后乳糜胸36例  

Postoperative Chylothorax Following Surgery for Congenital Heart Disease

作　　者：宓亚平[1] 贾兵[1] 李炘[1] 叶明[1] 陈张根[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心监护室,上海200032

出　　处：《实用儿科临床杂志》2009年第1期70-72,共3页Journal of Applied Clinical Pediatrics

基　　金：上海市重点学科建设项目资助(B116)

摘　　要：目的探讨先天性心脏病(先心病)术后并乳糜胸的临床特点、诊断及治疗策略。方法回顾性分析2000年1月-2008年1月于本院行先心病手术后出现的乳糜胸病例36例。年龄6d～4岁;体质量3.5～17.0kg。分别为法洛四联症根治术后18例,完全性房室隔缺损5例,右心室双出口术后、单心室类复杂先心病行Fontan手术后各4例,完全性肺静脉异位引流、主动脉缩窄术后各2例,动脉导管未闭结扎术后1例。乳糜胸发生在右侧32例,左侧3例,双侧1例。诊断时间为术后1～10d,平均6d。结果经保守治疗后34例(94.44%)痊愈,仅2例保守治疗无效,予手术结扎乳糜管分支后痊愈。饮食控制开始前胸腔引流量22～60mL/(kg.d),平均40.82mL/(kg.d),饮食控制如有效,胸腔引流量即开始逐步减少。胸腔闭式引流时间7～42d,平均15d。所有病例无院内死亡,2例患儿有脓毒症。随访2周～7a,1例新生儿出院后因其他病因放弃治疗。余患儿随访无乳糜胸复发,22例继续低脂饮食中。结论应警惕先心病手术后乳糜胸的发生,及时发现,早期治疗。治疗上应首选保守治疗,如保守治疗无效则需采取手术治疗。Objective To explore the clinical feature,diagnosis and treatment of postoperative chylothorax after congenital cardiac surgery. Methods From Jan. 2000 to Jan. 2008,36 consecutive infants following cardiac surgery were diagnosed postoperative chylothorax. Age at operation ranged 6 days to 4 years. Weight ranged 3.5 kg to 17.0 kg. Indications for cardiac surgery were ： tetralogy of Fallot 18 cases, com- plete atrioventricular septal defect 5 cases,double outlet of fight ventricle 4 cases, complex heart defect for Fontan operation 4 cases,coarctation of the aorta 2 cases,total anomalous pulmonary venous drainage 2 cases,patent ductus arteriosus 1 case. Chylothorax occurred in right side was 32 cases,in left side 3 cases,bilateral side 1 case. Diagnostic time for chylothorax was postoperative 1 - 10 d. Results Thirty - four cases were treated conservatively with success （34/36,94.44%）. Only 2 cases needed surgical treatment. The chest drainage volume before con-ser vative treatment was 22 - 60 mL/（ kg · d） [ mean 40.82 mL/（ kg · d） 1- The mean duration of chylous drainage was 15 d （ ranged 7 d to 42 d）. There was no death in hospital. Two children had sepsis. The eases were followed up 2 weeks - 7 years. One newborn was abandoned because of the other reason after discharge. There was no recurrence of chylothorax. Twenty - two cases were still in low - fat diet. Conclusions The chylothorax following operation of congenital heart disease should be noticed and early diagnosed. The initial treatment is conservative,but surgical treatment ought to be considered if the conservative management is unsuccessful.

关 键 词：乳糜胸 心脏病 先天性 心脏手术 

分 类 号：R726.5[医药卫生—儿科]