CAJ | 학술논문

目的探讨小儿先天性心脏病术后出现乳糜胸的治疗方法,促进先天性心脏病术后患儿尽早康复.方法北京儿童医院小儿心脏中心2010年1月至2012年6月共施行1 288例手术,出现乳糜胸18例,正中开胸手术1 120例,出现乳糜胸15例,侧开胸手术168例,出现乳糜胸3例.正中开胸组采用禁食7d左右,同时予全静脉营养,7 d后静脉营养减量的同时给予脱脂奶或中链脂肪酸饮食,2d左右停静脉营养,全量脱脂奶或中链脂肪酸饮食,直至1个月后复查.侧开胸组采用禁食2周加全静脉营养,然后给予脱脂奶或中链脂肪酸饮食.结果 17例乳糜胸患儿(包括15例正中开胸,2例侧开胸)通过禁食加静脉营养保守治疗治愈;另外1例双主动脉弓患儿保守治疗无效,通过左侧开胸二次手术结扎胸导管治愈.出院后2周、3个月复查胸片,超声,未发现胸腔或心包积液.结论无论正中开胸还是侧开胸小儿先天性心脏病手术均有可能发生乳糜胸.对于目的先天性心脏病术后乳糜胸的治疗,禁食仍是有效的首选治疗,北京儿童医院小儿心脏中心的经验显示加用静脉内营养治疗是安全的,有助于患儿恢复,禁食时间可以较常规缩短.对于可能为胸导管的直接损伤还是外科干预为好.
목적 탐토소인선천성심장병술후출현유미흉적치료방법,촉진선천성심장병술후환인진조강복.방법 북경인동의원소인심장중심2010년1월지2012년6월공시행1 288례수술,출현유미흉18례,정중개흉수술1 120례,출현유미흉15례,측개흉수술168례,출현유미흉3례.정중개흉조채용금식7d좌우,동시여전정맥영양,7 d후정맥영양감량적동시급여탈지내혹중련지방산음식,2d좌우정정맥영양,전량탈지내혹중련지방산음식,직지1개월후복사.측개흉조채용금식2주가전정맥영양,연후급여탈지내혹중련지방산음식.결과 17례유미흉환인(포괄15례정중개흉,2례측개흉)통과금식가정맥영양보수치료치유;령외1례쌍주동맥궁환인보수치료무효,통과좌측개흉이차수술결찰흉도관치유.출원후2주、3개월복사흉편,초성,미발현흉강혹심포적액.결론 무론정중개흉환시측개흉소인선천성심장병수술균유가능발생유미흉.대우목적선천성심장병술후유미흉적치료,금식잉시유효적수선치료,북경인동의원소인심장중심적경험현시가용정맥내영양치료시안전적,유조우환인회복,금식시간가이교상규축단.대우가능위흉도관적직접손상환시외과간예위호.
Objective To explore the treatment of postoperative chylothorax of congenital heart disease in children in order to improve the recovery of the children.Methods From Jan.2010 to Jun.2012,18 cases were diagnosed as postoperative chylothorax among the 1 288 cases in Beijing Children's Hospital,and 15 cases were from the 1 120 cases underwent median sternotomy,and 3 cases from the 168 cases received lateral thoracotomy.For the chylothorax cases of median sternotomy,fasting for 1 week with total parenteral nutrition (TPN) was prescribed,then decreasing the amount of TNP was decreased and skim milk or median chain triglyceride (MCT) diet was given and in the following 2 days only skim milk or MCT diet was given while reexamination was to be done 1 nonth after finding the postoperative chylothorax.For the cases of lateral thoracotomy,the fasting would last 2 weeks with TPN,then followed by skim milk and MCT diet.Results The 17 cases of postoperative chylothorax including 15 cases with median sternotomy and 2 cases of lateral thoracotomy recovered through fasting and TPN method.Only 1 case of lateral thoracotomy accepted second operation with ligation of thoracic duct finally.Rechecked with chest X-ray and ultrasound,no hydrothorax and hydropericardium was detected after discharge from hospital in about 2 weeks and 3 months.Conclusions Postoperative chylothorax may develop whether median sternotomy or lateral thoracotomy of congenital heart disease was performed.Now fasting is an important and effective method in treatment of postoperative chylothorax of congenital heart disease.Adopting TPN is safe from the experience of heart center in Beijing Children's Hospital for such kind of cases.Possible thoracic duct damage still needs surgical intervention.