PDF(Pubmed)
Abstract：
Gastroesophageal reflux disease (GERD) is a highly prevalent disease. Mechanical etiology, including hiatal hernia, can be resistant to empiric proton pump inhibitor (PPI) trials; Nissen fundoplication is commonly used to treat mechanical GERD. Chylothorax is a rare complication of abdominal surgeries, including anti-reflux procedures. In this case report, a 75-year-old female presented with shortness of breath following a redo laparoscopic Nissen fundoplication. Chest CT pulmonary angiography (CTPA) showed bilateral large pleural effusions that were managed by fluid restriction, repeated thoracocentesis, and chest tube insertion; the pleural fluid analysis was significant for fluid triglycerides high at 232 mg/dL which was diagnostic for chylothorax. The patient was treated conservatively. Appropriate management of chylothorax is crucial to avoid subsequent respiratory failure, immunodeficiency, and malnutrition. Chylomicrons and triglycerides in the pleural fluid can be diagnostic for chylothorax. Treatment of chylothorax includes three main approaches: controlling the cause, conservative treatment, and surgical interventions.
摘要：
胃食管反流病（GERD）是一种高度流行的疾病。机械病因学,包括食管裂孔疝,可对经验性质子泵抑制剂（PPI）试验耐药；尼森胃底折叠术通常用于治疗机械性GERD。乳糜胸是腹部手术的罕见并发症，包括抗反流程序。在这个案例报告中,1名75岁女性患者在重做腹腔镜Nissen胃底折叠术后出现呼吸急促.胸部CT肺动脉造影（CTPA）显示双侧大量胸腔积液，由液体限制管理，反复进行胸腔穿刺术,和胸管插入；胸膜液分析对232mg/dL的高甘油三酯具有重要意义，这是对乳糜胸的诊断。患者接受保守治疗。乳糜胸的适当管理对于避免随后的呼吸衰竭至关重要，免疫缺陷,和营养不良。胸膜液中的乳糜微粒和甘油三酯可诊断乳糜胸。乳糜胸的治疗包括三种主要方法：控制病因，保守治疗,和手术干预。
