新生儿先天性心脏病术后乳糜胸49例临床诊治分析  

Clinical analysis of chylothorax in 49 neonates after surgery for congenital disease

作　　者：张超英 孙云霞 刘玉梅 任媛 何少茹 Zhang Chaoying;Sun Yunxia;Liu Yumei;Ren Yuan;He Shaoru(Department of Neonatology,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510100,China)

机构地区：[1]广东省人民医院,广东省医学科学院新生儿科,广州510100

出　　处：《中华胸心血管外科杂志》2022年第2期71-74,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家重点研发计划项目(2018YFC1002600);广东省登峰计划科研专项(DFJH201802)。

摘　　要：目的探讨新生儿先天性心脏病术后出现乳糜胸的原因和治疗方法。方法回顾性分析2009年1月至2019年12月在广东省人民医院新生儿科住院新生儿期行先天性心脏病手术后出现的乳糜胸病例49例。分别为大血管转位矫正术13例,主动脉缩窄/主动脉弓离断术后13例,右心室流出道重建/改良B-T分流术后9例,完全性肺静脉异位引流8例,室间隔缺损修补+房间隔缺损修补术后4例,动脉导管未闭结扎术后1例,永存动脉干矫治术后1例。乳糜胸发生在右侧19例,左侧20例,双侧9例,心包1例。诊断时间为术后1~22天,平均8天。结果乳糜胸一旦诊断明确,即开始非手术治疗(禁食/中链脂肪酸奶粉喂养),治愈43例(87.75%),其中41例(83.67%)经饮食及支持治疗痊愈,治疗时间4~65天,平均11天;2例保守治疗无效,1例行化学胸膜固定术联合生长抑素维持治疗后痊愈,1例行手术治疗痊愈。死亡6例,为术后心功能差/严重肺动脉高压、病情危重家长放弃治疗。结论对于先天性心脏病术后乳糜胸,禁食待胸腔积液减少后逐渐予中链脂肪酸奶粉喂养仍是有效的首选治疗方法,对严重及恶性乳糜胸及时手术干预可提高患儿生存率,节省住院时间及费用。Objective To explore the cause and treatment of chylothorax after surgery for congenital heart disease(CHD)in newborns.Methods A retrospective analysis was made to the clinical data of 49 newborns with chylothorax after surgery for CHD within the period from January 2009 to December 2019.These newborns were aged from from 1 day to 28 days with the weight from 2.0 kg to 4.1 kg.The complete transposition of great arteries was performed in 13 cases,coarctation of the aorta/interruption of the aortic arch in 13 case,right ventricular outflow tract reconstruction/Blalock-Taussing shunt in 9 cases,total anomalous pulmonary venous connection in 8 cases,ventricular septal defect repair and atrial septal defect repair in 4 cases,ligation of patent ductus arteriosus in 1 case and persisten truncus arteriosus in 1 case.Chylothorax occurred in the right in 19 cases,left side in 20 cases,bilateral in 9 cases and the pericardium in 1 case.The diagnosis was made at the time from 1 day to 22 days after the surgery with an average of 8 days.Results 43 patients were cured(87.75%),41 cases(83.67%)were cured with diet and support therapy,the course lasted from 4 days to 65 days with an average of 11 days;1 cases,because of the poor effect of diet and support therapy,was given pleural injection of high-sugar combined with octreotide treatment;1 case received thoracic duct ligation as the conservative therapy was ineffective;6 cases of death due to heart failure/severe pulmonary hypertension after operation,and parents gave up.Conclusion Individualization conservative therapy is the first choice for chylothorax,while timely surgery can raise the survival rate and save the hospitalization time and the cost.

关 键 词：乳糜胸 先天性心脏病 术后并发症 

分 类 号：R722.1[医药卫生—儿科]