Surgical Management of Chylothorax

Paul, Subhankar; Altorki, Nasser K.; Port, J. L.; Stiles, B. M.; Lee, P. C.

doi:10.1055/s-0029-1185457

Cited by 100 publications

(75 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The placement of a pleuroperitoneal shunt is an effective option for refractory chlyothorax, [5][6][7] despite reported complications such as infection, shunt failure and pneumoperitoneum. 8,9) However, we could not control chylothorax by using a pleuroperitoneal shunt in the present case.…”

Section: Discussionmentioning

confidence: 99%

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

Oishi

Hoshikawa

Sado

et al. 2017

ATCS

View full text Add to dashboard Cite

A 37-year-old woman underwent bilateral lung transplantation for lymphangioleiomyomatosis. Dense pleural adhesions due to past pleurodesis for chylothorax were observed and dissected in both thoracic cavities. The patient developed chylothorax after transplant. Chylothorax in the right thoracic cavity was successfully treated by conventional pleurodesis; however, pleural effusion from the left thoracic cavity was not reduced. According to fluoroscopic images obtained by injecting a contrast medium through the chest tube, the remaining pleural space in the left thoracic cavity was small and localized in the lower region adjacent to the mediastinum. We opted to fill this space with fibrin glue; we injected fibrinogen and thrombin solution into the space through the chest tube. We performed fibrin glue treatment three times and pleural effusion was dramatically decreased. We removed the chest tube on day 107 post-transplant. No recurrent chylothorax has been recorded for 10 years after lung transplantation.

show abstract

Section: Discussionmentioning

confidence: 99%

A Case of Successful Therapy by Intrapleural Injection of Fibrin Glue for Chylothorax after Lung Transplantation for Lymphangioleiomyomatosis

Oishi

Hoshikawa

Sado

et al. 2017

ATCS

View full text Add to dashboard Cite

show abstract

“…Számos non-vagy szemi-invazív radiológiai kezelés is alkalmazható traumás és nem traumás chylothorax esetén egyaránt (2. táblázat) [4,8,34,36,[53][54][55][56][57][58][59][60][61], bár zö-mük néhány központra korlátozódik [62].…”

Section: Intervenciós Kezelésunclassified

“…A talkumpleurodesis sikerrátája 73-83% közötti [54,55]. A sebészi pleurodesis akkor is kezelési lehetőség, ha a chylothorax oka rosszindulatú daganat.…”

Section: Sebészi Kezelésunclassified

A chylothorax modern kezelésének bizonyítékalapú áttekintése

2016

View full text Add to dashboard Cite

A chylothorax napjainkban rendszerint műtéti vagy baleseti szövődmény, ritkábban daganat következménye. Prospektív vagy randomizált vizsgálatok hiányában a bizonyítékalapú kezelés személyes tapasztalaton, ideálisan a retrospektív elemzések ismeretében történik. A szerzők célja a chylothorax modern kezelésének áttekintése. A PubMed adatbázist "chylothorax" kulcsszóra szűrték az elmúlt tíz év közleményei között, kiemelve az összehasonlító értéke-léseket. A módszerek és ajánlások kritikai elemzésekor a szerzők együttes 39 éves klinikai tapasztalatukra támaszkod-tak. A konzervatív kezelés sikere az etiológiától függően nagy szórást mutat (3-90%). A non-és szemi-invazív intervenciós eljárások sikerrátája 50-100% közötti. Eredménytelen konzervatív kezeléskor a sebészi kezelés, elsősorban a ductus thoracicus lekötése jelenti a standard terápiát. Ezen beavatkozások sikerességi aránya 64-100% közötti, a morbiditási/mortalitási mutató elérheti a 25%-ot. A kezelést konzervatívan kell megkezdeni, majd egy lépcsőzetes agresszivitású terápia ajánlott, amelyben a beteg állapota és a drénvolumen irányítják a döntéshozatalt. Az intervenciós radiológiai eljárások biztonságosak, sikeresek és helyet kaptak a konzervatív és műtéti megoldások mellett. Orv. Hetil., 2016, 157(2), 43-51. Kulcsszavak: chylothorax, szövődmény, mellkassebészet Review of evidence-based modern treatment for chylothoraxChylothorax is a multi-factorial complication, frequently of an operation or an accident, but rarely of a tumour. In the absence of prospective or randomised studies evidence-based treatment is normally based on personal experience, ideally in the possession of retrospective analyses using the "best practice" method. The aim of the authors was the review the up-to-date chylothorax treatments. They performed the PubMed database's "chylothorax" keyword search of the publications reported in the last ten years. They put emphasis on articles that included a comparative analysis of the various treatment options. During the critical analysis of the methods and recommendations, the authors relied on their own joint experience amounting to 39 years. The results showed that the success of the initial conservative treatment indicates a signifi cant deviation depending on the etiology (3-90%). The success rate of noninvasive or semi-invasive interventions is between 50-100%, again depending on the etiology. The standard surgical treatment following an unsuccessful conservative treatment of an operable patient includes the fi tting of a (thoracoscopic) knot to the ductus thoracicus, pleurodesis, insertion of a permanent chest drain or a pleuroperitoneal shunt. The success rate of these interventions is between 64-100%, with a morbidity index and mortality index exceeding 25%. Conservative treatment should be the fi rst step, which should then be followed by a gradually increased aggressive therapy, during which the decisions should be made according to the patient's condition and the drain volume. Interventional radiology procedures are safe, successful an...

show abstract

“…Trigliserid düzeyi 110mg/dl'den büyük olan mayilerin %99'u şilöz iken trigliserid seviyesi 50mg/dl küçük olanların şilotoraks olma olasılığı %5'dir. Mikroskopik olarak Sudan III ile boyanan yağ globüllerinin görülmesi tanıyı kesinleştirir (41,54). Ayrıca alınan torasentez mayinin eter ile muamelesinde yağların çözünmesi şilotoraks tanısını destekler.…”

Section: Tanıunclassified

“…Ardından hastanın parenteral nütrisyonu başlanır. Parenteral nütrisyon için öncelik-le direkt portal venöz sisteme geçebilen orta zincirli trigliserid içeren mayiler başlanır (54). Konservatif tedavinin süresi lenfatik drenajın miktarına ve şiloto-raks nedenine bağlı olmakla birlikte, bu sürede farklılık göstermektedir.…”

Section: Tedaviunclassified