聚维酮碘胸膜融合术治疗婴儿先天性乳糜胸1例

IF 0.2 Q4 PEDIATRICS

Journal of Pediatric Surgery Case Reports Pub Date : 2025-03-12 DOI:10.1016/j.epsc.2025.102982

Citra Cesilia , Riky Candra , Hariadi Hatta , Nurhasanah , Muhammad Afdhal , Mutiara Arcan

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引用次数: 0

摘要

婴儿乳糜胸可分为先天性、外伤性、术后性、栓塞性和自发性五种类型，以自发性乳糜胸最为常见。其病因尚不完全清楚，它具有相对较高的死亡率，并且没有关于其治疗的标准化指南。1个月大的婴儿表现为呼吸急促加重，无发热或任何呼吸道感染迹象。胸部x光片显示大量右侧胸腔积液引起纵隔移位。将7Fr中心静脉导管置于右侧胸腔，左侧胸腔管引流。排出的液体呈乳白色，提示乳糜胸。体液分析证实甘油三酯升高患者最初接受全肠外营养（TPN）治疗。胸管每天引流几百毫升。在住院的第五天，我们开始了化学胸膜切除术的计划，使用2ml聚维酮碘、2ml利多卡因和8ml生理盐水的组合，通过胸腔引流。夹住胸管，病人频繁旋转。胸管被夹住了大约一个小时，之后就没有阻尼了。该程序每隔一天重复一次，最后一次是在住院的第12天。胸管输出量迅速下降，于住院第15天拔除胸管。患者在住院17天后出院，乳糜胸几乎完全消退。结论聚维酮碘化学胸膜融合术是治疗婴儿先天性乳糜胸的有效方法。

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Povidone-iodine pleurodesis for congenital chylothorax in an infant: A case report

Introduction

Chylothorax in infants can be classified into five types: congenital, traumatic, postoperative, embolic, and spontaneous, the last one being the most common one. Its etiology is not fully understood, it has a relatively high mortality rate, and there are no standardized guidelines regarding its treatment.

Case presentation

A I-month-old infant presented with worsening shortness of breath, without fever or any signs of an airway infection. A chest X-ray revealed a large right pleural effusion causing mediastinal shift. The fluid was drained with a 7Fr central venous catheter placed in the right pleural cavity and left as a chest tube. The fluid that was drained had a milky appearance, suggestive of chylothorax. Fluid analysis confirmed elevated triglycerides. The patient was initially managed with total parenteral nutrition (TPN). The chest tube drained several hundred milliliters per day. On the fifth day of hospitalisation, we initiated a plan of chemical pleurodesis using a combination of 2 mL of povidone-iodine, 2 mL of lidocaine, and 8 mL of normal saline, administered through the chest drain. The chest tube was clamped and the patient rotated frequently. The chest tube was clamped for about an hour and undamped thereafter. The procedure was repeated every other day, the last one being on the twelfth day of hospitalisation. The output of the chest tube decreased rapidly, and the chest tube was removed on the fifteenth day of hospitalisation. The patient was discharged after seventeen days of hospitalisation with near complete resolution of the chylothorax.