Chylothorax is a rare complication following cardiac surgery for congenital heart diseases. Although conservative management is successful in the majority of cases, surgical intervention is required in a refractory one. Recently, subcutaneous or intravenous infusion of octreotide has been used as a safe treatment that helps avoiding surgical intervention. Herein, we report two cases of postoperative chylothorax treated with parenteral octreotide and conservative therapy.
Chylothorax* ; Heart Diseases ; Infusions, Intravenous ; Octreotide* ; Postoperative Complications ; Thoracic Surgery

Objective To investigate the clinical characteristics of 30-day unplanned reoperations after thoracic surgery. Methods We retrospectively analyzed the clinical data of patients with unplanned reoperations within 30 days after thoracic surgery in Peking Union Medical College Hospital from May 2016 to May 2021. Results The 30-day unplanned reoperations showed the incidence of 0.75%(79/10 543),the median hospital stay of 19(12,37) days,and the median hospitalization cost of 109 929.11(80 549.46,173 491.87) yuan.Twenty-two(27.85%) patients received blood transfusion and 26(32.91%) underwent intensive care.The period between May 2016 and May 2017 witnessed the most unplanned reoperations.The main causes of unplanned reoperations after thoracic surgery were bleeding(21.52%),chylothorax(17.72%),pulmonary air leakage(16.46%),atelectasis(13.92%),and gastroesophageal fistula(11.39%).Specifically,the main causes of unplanned reoperations in the patients of non-esophagus/cardia group were bleeding,pulmonary air leakage,atelectasis,and chylothorax,and those in the patients of esophagus/cardia group were gastroesophageal fistula,incision infection and poor healing,bleeding,and chylothorax.Among all the patients with unplanned reoperations,4 patients died,17 improved,and 58 recovered. Conclusions The patients who underwent unplanned reoperations after thoracic surgery had a long hospital stay and high hospitalization costs. Bleeding,chylothorax,pulmonary air leakage,atelectasis,and gastroesophageal fistula were the main reasons for the unplanned reoperations.
Humans ; Reoperation ; Retrospective Studies ; Thoracic Surgery ; Chylothorax/surgery* ; Hemorrhage ; Pulmonary Atelectasis/surgery* ; Postoperative Complications/epidemiology*

Carcinoma ; diagnosis ; surgery ; Chylothorax ; diagnosis ; Humans ; Lymph Node Excision ; Thyroid Neoplasms ; diagnosis ; surgery

Substernal goiter is defined as a thyroid mass of which more than half is located below the thoratic inlet. Substernal goiters must be removed surgically due to relation to compressive symptoms, potential airway compromise, and the possibility of an association with malignancy. Thyroidectomy for substernal goiter is usually carried out through a standard cervical approach. However, a few patients with various factors require an extracervical approach, usually by sternotomy. Recently, we successfully removed a substernal goiter that extended to the lower level of the aorta and tracheal carina though the combined cervical and video-assisted thoracoscopic approach. We present this case with a review of the literature.
Aorta ; Bays ; Chylothorax ; Goiter, Substernal* ; Humans ; Sternotomy ; Thoracic Surgery, Video-Assisted ; Thyroid Gland ; Thyroidectomy

The causes of the chylothorax can be classified to the congenital cases, such as the atresia of thoracic duct and thoracic duct-pleura fistula, and the acquired ones, such as thoracic surgery, trauma, malignant disease, venous thrombosis, infection and so on. We experienced a case of left chylothorax in a 10-year-old girl with a lymphangiomatosis of left thorax extending from axillar to buttock. She first received the two weeks of conservative management, which was unsuccessful to subside the chylothorax. Then she was taken the partial pleurectomy and chemical pleurodesis under the thoracoscopy as a surgical intervention, but this is also insufficient to reduce the chylous effusion. Finally she received 10 times of radiotherapy on left thorax, then the chylothorax is controlled completely.
Buttocks ; Child ; Chylothorax* ; Female ; Fistula ; Humans ; Pleurodesis ; Radiotherapy* ; Thoracic Duct ; Thoracic Surgery ; Thoracoscopy ; Thorax* ; Venous Thrombosis

A 45-year-old woman was diagnosed as having chylothorax after a mitral valve replacement for mitral stenosis. direct injury of lymphatics in thymus a ramification of thoracic duct was presumed to be responsibe for this complication. Four weeks of conservative treatment failed and surgical treatment was performed, We report a case of surgical treatment for chlyothorax after and open heart surgery.
Chylothorax* ; Female ; Humans ; Middle Aged ; Mitral Valve ; Mitral Valve Stenosis ; Thoracic Duct ; Thoracic Surgery* ; Thymus Gland

BACKGROUND: Postoperative chylothorax may be caused by iatrogenic injury of the collateral lymphatic ducts after thoracic surgery. Although traditional treatment could be considered in most cases, resolution may be slow. Radiological interventions have recently been developed to manage postoperative chylothorax. This study aimed to compare radiological interventions and conservative management in patients with postoperative chylothorax.METHODS: We retrospectively reviewed periprocedural drainage time, length of hospital stay, and nil per os (NPO) duration in 7 patients who received radiological interventions (intervention group [IG]) and in 9 patients who received conservative management (non-intervention group [NG]).RESULTS: The baseline characteristics of the patients in the IG and NG were comparable; however, the median drainage time and median length of hospital stay after detection of chylothorax were significantly shorter in the IG than in the NG (6 vs. 10 days, p=0.036 and 10 vs. 20 days, p=0.025, respectively). NPO duration after chylothorax detection and total drainage duration were somewhat shorter in the IG than in the NG (5 vs. 7 days and 8 vs. 14 days, respectively).CONCLUSION: This study showed that radiological interventions reduced the duration of drainage and the length of hospital stay, allowing an earlier return to normal life. To overcome several limitations of this study, a prospective, randomized controlled trial with a larger number of patients is recommended.
Chylothorax ; Drainage ; Humans ; Length of Stay ; Lymphography ; Postoperative Care ; Prospective Studies ; Retrospective Studies ; Thoracic Duct ; Thoracic Surgery

OBJECTIVETo define the clinical features of postoperative chylothorax for lung cancer (PCLC), and to compare them with those for esophageal cancer (PCEC).

METHODWe retrospectively analysed clinical characteristics of 12 patients with chylothorax among 4 084 patients receiving resection of lung cancer, as well as 52 in 4 479 patients having resection of esophageal cancer since 1985 at our hospital.

RESULTSThe incidence of PCLC was 0.29% and that of PCEC was 1.16%. The percentage of diagnosis confirmed within 4 postoperative days was 33.3% for PCLC, and 76.9% for PCEC. The rate of typical chylous pleural effusion was 83.3% for PCLC, and 5.8% for PCEC. Symptoms and signs of PCLC were much milder than those of PCEC. The re-operation rate was 16.7% for PCLC, and 96.2% for PCEC. All patients were discharged uneventfully.

CONCLUSIONThe incidence, causes, clinical manifestations, diagnosis, and treatment of PCLC is different from those of PCEC.

Adult ; Aged ; Chylothorax ; etiology ; therapy ; Esophageal Neoplasms ; surgery ; Female ; Humans ; Lung Neoplasms ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology

OBJECTIVETo investigate the effect of thoracic duct ligation during transthoracic esophagectomy on preventing post-operative chylothorax in different tumor locations.

METHODSBetween March 2003 and June 2007, 243 patients with thoracic esophageal carcinoma underwent esophageal resection in our hospital. All the cases were divided into five groups according to tumor localization, including cervical, upper middle, middle, lower middle and lower sections. Each was then subdivided into 2 groups: with and without intraoperative thoracic duct ligation. Statistical analysis was carried out to evaluate the relevance between ligation and non-ligation of the thoracic duct during esophagectomy and the incidence of post-operative chylothorax.

RESULTSA total of 8 cases of post-operative chylothorax was recorded and the incidence was 3.3%. Incidence with respect to tumor location was as follows: cervical section: ligation subgroup 3 cases and non-ligation subgroup 5 cases; upper middle section: no one for both ligation and non-ligation subgroups; middle section: ligation subgroup 0/26 and non-ligation subgroup 1/28 (3.6%); lower middle section: ligation subgroup 1/39 (2.6%) and non-ligation subgroup 1/35 (2.9%); lower section: ligation subgroup 1/37 (2.7%) and non-ligation subgroup 2/44 (4.5%). Logistic regression analysis revealed no significant difference between ligation and non-ligation subgroup in the prevention of post-operative chylothorax (P>0.05).

CONCLUSIONThoracic duct ligation as preventive measure can not decrease the incidence of chylothorax secondary to esophagectomy.

Aged ; Chylothorax ; etiology ; prevention & control ; surgery ; Esophageal Neoplasms ; surgery ; Esophagectomy ; adverse effects ; Female ; Humans ; Ligation ; Male ; Middle Aged ; Postoperative Complications ; prevention & control ; surgery ; Thoracic Duct ; surgery

This study reports our early experience with thoracoscopic division of vascular rings. Three patients were reviewed; their ages at surgery were 25 months, 4 years, and 57 years. All patients were suffering from complete vascular rings involving combinations of the right aortic arch, left ligamentum arteriosum, Kommerell's diverticulum, and retroesophageal left subclavian artery. The median surgical time was 180.5 minutes, and the patients showed immediate recovery. Three complications, namely chylothorax, transient supraventricular tachycardia, and left vocal cord palsy, were observed. Our early experience indicates that thoracoscopic division of a vascular ring may provide early recovery and could be a promising operative choice.
Aorta, Thoracic ; Chylothorax ; Diverticulum ; Humans ; Operative Time ; Subclavian Artery ; Tachycardia, Supraventricular ; Thoracic Surgery, Video-Assisted ; Vocal Cord Paralysis