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The changing management of chylothorax in the modern era.
- Source :
-
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2016 Jan; Vol. 49 (1), pp. 18-24. Date of Electronic Publication: 2015 Mar 01. - Publication Year :
- 2016
-
Abstract
- Initial conservative therapy is applied to all cases of chylothorax (CTx) with expected excellent outcomes. The indication for aggressive surgical treatment of early CTx remains uncertain and requires rigorous scientific scrutiny. Lymphangiography and lymphoscintigraphy are useful to localize the leak and assess thoracic duct patency as well as to differentiate partial from complete thoracic duct transection. The aetiology of the CTx, flow rate and patient condition dictate the preferred management. Octreotide/somatostatin and etilefrine therapy is highly efficacious in the conservative management of CTx. For patients in whom conservative management fails, those who are good surgical candidates, and those in whom the site of the leak is well identified, surgical repair and/or ligation using minimally invasive techniques is highly successful with limited adverse outcomes. Similarly, if the site of the chylous effusion cannot be well visualized, a thoracic duct ligation via video-assisted thoracic surgery is the gold standard approach. A pleuroperitoneal or less often a pleurovenous shunt is a final option and may be curative in some patients.<br /> (© The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Subjects :
- Chylothorax etiology
Disease Management
Female
Forecasting
Humans
Ligation methods
Lymphography methods
Male
Octreotide therapeutic use
Radiography, Thoracic methods
Severity of Illness Index
Somatostatin therapeutic use
Tomography, X-Ray Computed methods
Chylothorax diagnostic imaging
Chylothorax therapy
Drainage methods
Pleurodesis methods
Thoracic Surgery, Video-Assisted methods
Subjects
Details
- Language :
- English
- ISSN :
- 1873-734X
- Volume :
- 49
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 25732972
- Full Text :
- https://doi.org/10.1093/ejcts/ezv041