ABSTRACT
Postoperative chylothorax remains a clinical challenge to the surgeon with substantial morbidity and risk of mortality. Though an uncommon complication, it is known to complicate cardiac and non-cardiac thoracic surgeries. Conservative measures are first employed in managing this. Surgical options are adopted when the effusion is protracted, most recent of which includes diaphragmatic fenestration. A 9-year-old girl is presented who developed recurrent right chylothorax following thoracoscopic excision of a cystic lymphangioma. Following failed conservative therapy, she had thoracic duct ligation and right diaphragmatic fenestration (using fenestrated polytetrafluoroethylene patch) with satisfactory outcome. Aetio-pathologic mechanisms implicated in postoperative chylothorax have been classified into traumatic (iatrogenic injury to the thoracic duct or its branches) and non-traumatic. With initial conservative measures (repeated pleural aspirations and intercostal drainage, medium chain triglyceride/ low fat feeds or alternatively, fasting and total parenteral nutrition) spontaneous closure remains unpredictable. Diaphragmatic fenestration when employed resulted in faster resolution of effusion and earlier commencement of enteral feeding with no significant complication. Diaphragmatic fenestration is effective and safe for treating refractory post-operative chylothorax.
ABSTRACT
Objective To investigate the therapeutic effect of aminophylline on the treatment of patients with thoracic surgery perioperative. Methods 230 cases with thoracic surgery were selected as the research objects and divided into the research group and the control group randomly, and there was 15 cases in each group. the control group were ginven closed drainage of thoracic cavity during the surgery, continued to 3 days after surgery. The control group were given intravenous drip of ciprofloxacin lactate injection at 12 h after operation, and the treatment lasted for 7 days. At this basis, the research group were given aminophylline 0.5 mg/d by intravenous injection at the beginning of anesthesia induction and continued for 3 days. The levels of lung and respiratory inflammation related factor (White blood cells, PCT, hs-CRP, TNF-α, IL-6, IL-8 and IL-10), blood gas index in the two groups pre- and post–surgery were detected, and the complications and adverse drug reactions were observed. Results 24h after surgery, TNF alpha, IL-6, IL-8 were significantly lower than those in the control group (P<0.05), and IL-10 level was significantly higher than that in the control group (P<0.05). And PaO2 in the research groupwas significantly higher than that in the control group patients (P<0.05). After treatment, arterial carbon dioxide partial pressure (PaCO2) in the two groups were significantly lower than preoperative (P<0.05). The complication rate in the research group was significantly lower than that in the control group within ten days(P<0.05). There were no adverse reactions in both groups. Conclusion During the perioperative period in thoracic surgery, aminophylline intervention can effectively improve the prognosis. .