小儿先天性心脏病术后乳糜胸的治疗  

Treatment of postoperative chylothorax on congenital heart diseases in children

作　　者：郭健[1] 李晓峰[1] 刘晖[1] 袁锋[1] 柏松[1] 赵宇东[1] 郑佳[1] 丁楠[1] 李奇林[1] 

机构地区：[1]首都医科大学附属北京儿童医院小儿心脏中心心脏外科,100045

出　　处：《中华实用儿科临床杂志》2014年第5期351-353,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨小儿先天性心脏病术后出现乳糜胸的治疗方法，促进先天性心脏病术后患儿尽早康复。方法北京儿童医院小儿心脏中心2010年1月至2012年6月共施行1288例手术，出现乳糜胸18例，正中开胸手术1120例，出现乳糜胸15例，侧开胸手术168例，出现乳糜胸3例。正中开胸组采用禁食7d左右，同时予全静脉营养，7d后静脉营养减量的同时给予脱脂奶或中链脂肪酸饮食，2d左右停静脉营养，全量脱脂奶或中链脂肪酸饮食，直至1个月后复查。侧开胸组采用禁食2周加全静脉营养，然后给予脱脂奶或中链脂肪酸饮食。结果17例乳糜胸患儿（包括15例正中开胸，2例侧开胸）通过禁食加静脉营养保守治疗治愈；另外1例双主动脉弓患儿保守治疗无效，通过左侧开胸二次手术结扎胸导管治愈。出院后2周、3个月复查胸片，超声，未发现胸腔或心包积液。结论无论正中开胸还是侧开胸小儿先天性心脏病手术均有可能发生乳糜胸。对于同前先天性心脏病术后乳糜胸的治疗，禁食仍是有效的首选治疗，北京儿童医院小儿心脏中心的经验显示加用静脉内营养治疗是安全的，有助于患儿恢复，禁食时间可以较常规缩短。对于可能为胸导管的直接损伤还是外科干预为好。Objective To explore the treatment of postoperative chylothorax of congenital heart disease in chil- dren in order to improve the recovery of the children. Methods From Jan. 2010 to Jun. 2012,18 cases were diagnosed as postoperative chylothorax among the 1 288 cases in Beijing Children＇s Hospital,and 15 cases were from the 1 120 ca- ses underwent median sternotomy,and 3 cases from the 168 cases received lateral thoracotomy. For the chylothorax ca- ses of median sternotomy, fasting for 1 week with total parenteral nutrition （TPN） was prescribed, then decreasing the amount of TNP was decreased and skim milk or median chain triglyceride （MCT） diet was given and in the following 2 days only skim milk or MCT diet was given while reexamination was to be done 1 month after finding the postoperative chylothorax. For the cases of lateral thoraeotomy, the fasting would last 2 weeks with TPN, then followed by skim milk and MCT diet. Results The 17 cases of postoperative chylothorax including 15 cases with median sternotomy and 2 ca- ses of lateral thoracotomy recovered through fasting and TPN method. Only 1 case of lateral thoracotomy accepted second operation with ligation of thoracic duct finally. Rechecked with chest X-ray and ultrasound, no hydrothorax and hydro- pericardium was detected ＇after discharge from hospital in about 2 weeks and 3 months. Conclusions Postoperative chylothorax may develop whether median sternotomy or lateral thoracotomy of congenital heart disease was performed. Now fasting is an important and effective method in treatment of postoperative chylothorax of congenital heart disease. A- dopting TPN is safe from the experience of heart center in Beijing Children＇s Hospital for such kind of cases. Possible thoracic duct damage still needs surgical intervention.

关 键 词：乳糜胸 先天性心脏病 肠道外营养 

分 类 号：R726.5[医药卫生—儿科]