儿童乳糜胸外科治疗26例  

Clinical analysis of chylothorax in 26 childen with surgical treatment

作　　者：徐冰[1] 何姿容 刘文英[1] 

机构地区：[1]四川省医学科学院,四川省人民医院小儿外科,四川省成都市610072

出　　处：《临床小儿外科杂志》2017年第2期182-184,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨乳糜胸的治疗经验与胸腔镜手术方法。方法 2010年6月至2015年2月本院收治26例乳糜胸患儿,其中男性14例,女性12例,年龄1个月13天至17岁9个月(平均7岁8个月),感染性或原因不明19例,外伤5例,胸部手术后2例。26例均常规安置胸腔闭式引流,7例行胸腔镜手术治疗。结果 26例均痊愈出院,住院治疗时间22~57 d。经非手术治疗痊愈19例。胸腔镜手术治疗7例,术前均严格禁食禁饮2周以上(2~8周)无缓解,其中1例保守治疗2周,好转4周后又复发。7例经胸腔镜手术治疗的患儿中3例为肺部感染后乳糜胸,2例为胸部外伤后乳糜胸,1例为胸部手术后乳糜胸,1例病因不明确。其中6例行右侧入路胸腔镜下胸导管结扎加局部胸膜固定手术,1例行左侧入路。均顺利完成手术,手术时间42~95 min,平均70 min;出血量4~30 mL,平均15 mL,术后未发生伤口及胸腔内感染,术后1周复查胸片,肺部复张无积液,拔除胸腔引流管,术后8~10 d出院,平均9 d。随访14例非手术治疗和7例手术辅助治疗患儿,均无复发。结论临床治疗乳糜胸一般首选的治疗方法为非手术治疗,并且禁食、禁饮及对症支持治疗的时间要足够长,大多数能获得良好效果。严格禁食、禁饮基础上非手术治疗观察2周以上仍然无缓解者,则可以考虑选择胸腔镜手术辅助治疗。手术中不能清楚结扎处理胸导管者,可以采用局部胸膜固定手术,同样效果良好。Objective To review our experiences in chylothorax with surgical treatment and thoracoseop- ic surgery. Methods A total of 26 patients with ehylothorax received surgical treatment. There were 14 boys and 12 girls with an average age of 92 （1.43 -213） months. Causes of chylothorax included infection or un- known cause（ n = 19） , trauma（ n = 5 ） and after thoracic surgery （n = 2 ）. All 26 cases were put the chest closed drainage, 26 cases with chylothorax were treated with surgical treatment for conditions. Results All 26 cases were recurred. The mean time from inpatient to discharge was 26 （ 22 -57 ） days. 19 cases were treat- ment with non-operation therapy, 7 cases were treatment with thoracoscopic surgery. Causes of ehylothorax （ n = 7）, infection （ n = 3 ）, trauma （.n = 2）, after thoracic surgery （ n = 1 ） and unknown （ n = 1 ）. There were 2 weeks strict fasting before operation in 7 cases. The average operative duration was 70 （42 - 95 ） min, the av- erage intraoperative bleeding volume 15 （4 - 30） ml and the average time from operation to discharge 9 （8 - 10） days. Twenty-one cases were followed up for an average period of 25 （12 -61 ） months. Conclusions Preferred treatment of chylothorax generally should be conservative ;and then according to the condition accompanied by surgical treatment. Time of fasting, forbidden to drink avoidance venous high - nutrition supportive should be long enough so so as to achieve excellent outcomes. If conservative treatment is ineffective after 2 weeks, thora- coscopic surgery may be adopted. If thoracic duct ligation is difficult, partial pleurodesis offers excellent effica- eies.

关 键 词：乳糜胸 外科手术 治疗 儿童 

分 类 号：R726.5[医药卫生—儿科]