小儿先天性心脏病术后乳糜胸的诊断和治疗  

Diagnosis and Management of Chylothorax in Children after Congenital Heart Surgery

作　　者：郭予雄[1] 何少茹[2] 钟敏泉[1] 粱穗新 孙跃玉 陈寄梅[3] 庄建[3] 

机构地区：[1]广东省人民医院广东省医学科学院儿科重症监护病房 [2]广东省人民医院广东省医学科学院新生儿科 [3]广东省人民医院广东省医学科学院广东省心血管病研究所心外科,广州510080

出　　处：《中国胸心血管外科临床杂志》2015年第8期734-738,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑计划课题(2011BAI11B22)~~

摘　　要：目的探讨小儿先天性心脏病(congenital heart disease,CHD)矫治术后并发乳糜胸的临床特点、诊断及治疗策略。方法回顾性分析广东省人民医院2006年1月至2013年12月CHD术后发生乳糜胸79例的临床资料,其中男54例、女25例,年龄8 d至14岁,体重(8.1±6.7)kg。结果 CHD手术共实施12 607例,乳糜胸发生率为0.6%。共治愈75例(94.9%),71例(89.9%)经保守治愈,4例(5.1%)内科治疗无效后实施手术,包括3例胸导管结扎,1例淋巴管消融烧灼。4例(5.1%)治疗失败,其中1例放弃出院(1.3%);3例(3.8%)分别死于大动脉转位行心房调转术后低心排血量综合征、法洛四联症矫治术后心搏骤停、肺静脉异位引流矫治术后吻合口严重狭窄。住院时间10~108(39.3±19.4)d。随访6个月至8年,无复发病例。结论提高婴幼儿先心病外科治疗技术是预防乳糜胸的关键。治疗上应首选保守治疗,如保守治疗无效建议尽早手术。Objective To investigate the clinical characteristics,diagnosis and management of postoperative chylothorax after congenital cardiac surgery in infants and children.Methods We 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.Results The 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.Conclusions The 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.

关 键 词：乳糜胸 小儿 先天性心脏病 心脏手术 

分 类 号：R726.5[医药卫生—儿科]