EXPERIENCE OF SURGICAL TREATMENT OF CHYLOTHORAX
Abstract
Introduction. A chylothorax is usually called an accumulation of lymph in the pleural cavity. The optimal treatment tactics for chylothorax is still controversial and depends on hospital standards. The aim of the study: retrospective analysis of cases of providing specialized medical care to patients with chylothorax of different genesis. Materials and methods. The study presents result of treatment of 27 patients with chylothorax who were treated in surgical departments of St. Petersburg State Budgetary Institution “City Hospital No. 26” in the period from 2012 to 2022. The average age of patients was 55.1±16.61 years. Depending on the nature of chylothorax development, the patients were divided into two groups: posttraumatic chylothorax (n=14) and chylothorax that occurred on the background of various advanced oncologic pathology (n=13). Results and discussion. Treatment started with the conservative stage, which included drainage of pleural cavity, administration of octreotide, parenteral nutrition for 7–10 days. Conservative therapy was effective only in 5 out of 27 cases. In case of absence of positive changes, clipping or ligation of the thoracic lymphatic duct in the supradiaphragmatic region was performed. Positive outcomes were obtained in all cases, cessation of chylorrhea, lung repair within 2 to 8 days. In patients with non-traumatic genesis of chylothorax the duration of postoperative period was slightly longer. The results of thoracic duct clipping did not differ from ligation of the whole cellular complex in the supradiaphragmatic region between the descending aorta, esopha gus and v. azygos. Conclusion. Supradiaphragmatic ligation of the thoracic lymphatic duct is a highly effective treatment option for chylothorax of various genesis. Detection of the thoracic lymphatic duct may be difficult. In this case, the operation of choice is ligation of the entire cellular mass, located between the esophagus, the medial wall of the descending aorta and v. azygos.
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