[Surgical management of chylothorax: a report of 65 cases]

Sixty-five cases of chylothorax treated at the Shanghai Chest Hospital over the past 30 years are reviewed. The causes of chylothorax in this series were mainly traumatic and postoperative (47/65). Two cases were associated with chylopericardium and another 2 with chylous sputum. The authors believe that untreated chylothorax is a serious, often life-threatening entity and that the following principles are applicable in its management: (1) If daily chyle loss exceeds 1000 ml in adults with no tendency of subsidence, surgery is indicated especially in the effusion may lead to disastrous nutritional and immunologic consequences; (2) Ligation of the thoracic duct is effective by a mass ligature encircling all tissues between the azygos vein and the aorta. The most favorable site for ligation is immediately above the diaphragm. Over dissection of the thoracic duct should be avoided; (3) The proper surgical approach is on the side of the effusion in unilateral chylothorax, but right side approach is preferred in case of bilateral chylothorax or when the origin of chylous fistula is unknown; (4) Pleurodesis is indicated for those cases if the duct is not obviously present or chyle comes from the pleural lymphatics. Concentrated glucose solution with or without Talc suspension is recommendable.