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医药导报, 2016, 35(12): 1369-1373
doi: 10.3870/j.issn.1004-0781.2016.12.018
注射用A群链球菌治疗新生儿先天性乳糜胸2例及文献复习
Treatment with Streptococcus A Group for Injection for Congenital Chylothorax in Newborn Infants: Two Case Report and Literature Review
专晨昱, 陈玲, 周鸿敏

摘要:

目的 提高对注射用A群链球菌治疗新生儿先天性乳糜胸的认识。方法 对2013年—2015年2例新生儿先天性乳糜胸采用注射用A群链球菌治疗痊愈的患儿进行分析,并对注射用A群链球菌治疗乳糜胸在万方数据库和PubMed数据库进行检索,检索时间从建库至2015年6月,共38篇文献入选,其中采用胸膜腔内注入注射用A群链球菌的胸膜固定术治疗新生儿和胎儿乳糜胸报道共18篇,共87例先天性乳糜胸。对此87例及该文2例共89例患儿临床资料及注射用A群链球菌胸膜腔固定术的治疗反应进行总结。结果 ①本文2例患儿均为足月儿,入院胸腔穿刺后确诊新生儿先天性乳糜胸,分别于出生后第24天和第1天入院,均经过胸腔闭式引流和控制饮食等治疗,效果不佳,分别于入院第20天和第5天予以胸腔内注入注射用A群链球菌治疗,胸腔积液迅速得到控制,痊愈出院。②89例患儿中有80例为产前采用注射用A群链球菌胸膜固定术宫内给药治疗先天性乳糜胸,其中基因突变相关或染色体核型异常的共有18例,14例均宫内死亡,2例核型异常的患儿在乳糜胸成功治疗后出生不满1岁死亡;23例对注射用A群链球菌胸膜固定术部分有效(胸腔积液未完全吸收),余41例均疗效显著,无明显不良反应。另7例新生儿乳糜胸为出生后保守治疗或奥曲肽治疗无效后改用注射用A群链球菌治疗,效果显著。该文2例先天性乳糜胸均采用胸腔引流、饮食控制及联合注射用A群链球菌治愈。结论 对先天性乳糜胸新生儿在闭式胸腔引流的基础上早期联合胸膜腔内注射注射用A群链球菌的胸膜固定术,可快速减少乳糜液渗出而早日拔除胸导管,减少感染等相关并发症风险,缩短禁食和住院时间。

关键词: A群链球菌 ; 注射用 ; 乳糜胸 ; 先天性/新生儿 ; 胸膜固定术

Abstract:

Objective To improve the understanding of treatment with streptococcus a group for injection (SAGI) for neonatal congenital chylothorax. Methods The therapeutic effect of intrapleural injection of SAGI in two newborn infants with congenital chylothorax was analyzed and the literatures was reviewed from Wanfang and PubMed database until June 2015. Finally 38 articles were screened including 18 articles of neonatal and fetal chylothorax treated with intrapleural injection of SAGI, and a total of 87 cases of congenital chylothorax. The clinical data and the newborn's therapeutic response to SAGI of 87 cases and the 2 cases in this study were summarized. Results Two cases of full term were diagnosed of newborn congenital chylothorax according to pleural puncture and respectively admitted to the hospital on the 24th and 1st day after birth .The therapeutic response was not good through the chest drainage or diet treatment, then pleurodesis by intrapleural injection of SAGI was applied on the 20th day and 5th day after admission, respectively and chylous fluid was reduced sharply, finally the patients were recovered and discharged from the hospital. Totally, 80 cases out of the 89 cases were antenatally treated with pleurodesis with SAGI for congenital chylothorax, and 18 cases had gene mutation related diseases or abnormal chromosome karyotype. Intrauterine death occurred in 14 cases and 2 cases of abnormal chromosome karyotype died less than one year old after successful treatment about chylothorax. Twenty-three cases were partially effectively treated, while 41 cases had obvious curative effect. In the other 7 cases of neonatal chylothorax, the treatment efficacy of SAGI after conservative treatment or octreotide administration after birth was remarkable. In this paper, congenital chylothorax in the two cases achieved rapid and effective control due to chest drainage, diet control and combination with SAGI. Conclusion That SAGI should be considered as a therapeutic option for neonatal chylothorax, and its earlier usage may bring with expectation of the quick reduction of the chylous fluid, early removal of the chest tube, less risk of complication related to infection and less time of fasting and hospitalization.

Key words: Streptococcus a group for injection ; Chylothorax ; congenital/newborn infants ; Pleurodesis

新生儿乳糜胸是由于各种原因引起的胸导管或胸腔淋巴管破裂使淋巴液漏入胸腔所致。新生儿乳糜胸是新生儿胸腔积液最常见的类型。该病在出生婴儿中的发病率为1/10 000,在新生儿重症监护病房(NICU)中的发病率为1/2 000[1],此病会引起严重的呼吸、营养及免疫障碍,是一种严重威胁新生儿生命的疾病,病死率较高,为20%~50%[1],好的预后取决于早期诊断及治疗。新生儿先天性乳糜胸治疗目前多采取包括饮食调节、胸腔引流术等在内的保守治疗,但往往病程较长,部分疗效不佳或继发感染等。注射用A群链球菌是一种经热及青霉素处理的B族溶血性链球菌A群722低毒株的冷冻干粉剂,主要用于成人的恶性胸腔积液及儿童的胸腔术后并发的乳糜胸及囊性淋巴管畸形的治疗[2-4]。也有相关报道注射用A群链球菌用于胎儿乳糜胸的治疗[5-8]。然而其在新生儿应用的报道很少,国内更鲜见报道。现报道我科近年来应用注射用A群链球菌制剂(商品名:沙培林)胸腔内注射成功治疗2例新生儿先天性乳糜胸病例,并检索、复习至2015年6月国内外相关文献,旨在进一步提高新生儿乳糜胸的治疗水平及评价注射用A群链球菌的效果及不良反应。

1 病例概况

例1,患儿,男,24 d,因“腹泻偶伴呼吸急促10余天”入院。患儿系G2P1G40+2周,出生体质量3.95 kg,因“胎儿过大”行剖宫产出生,出生时一般情况可,新生儿阿氏评分(apgar评分)不详,羊水多,性质不详,脐带绕颈一周,胎盘无异常。入院10 d前无明显诱因出现腹泻,偶有气促,后逐渐加重,大便黄色水样,8次·d-1,至当地医院诊断为“新生儿腹泻病、新生儿肺炎、左侧胸腔积液、代谢性酸中毒、心肌受损”,住院期间予以抗感染(用药不详)及丙种球蛋白支持等治疗,患儿腹泻好转,仍偶有气促转入我院治疗。患儿自发病以来,精神反应欠佳,足月奶80 mL,大便黄糊状。既往史:患儿生后第3天出现黄疸,予以光疗退黄治疗好转。入院体检:体温37.4 ℃,脉搏130次·min-1,呼吸40次·min-1,血压78/45 mmHg(1 mmHg=0.133 kPa),体质量4.39 kg。精神反应一般,前囟平软,全身皮肤稍苍白,无水肿,口唇红润,偶有呼吸急促,未见明显鼻翼扇动及三凹征。双肺呼吸音粗,未闻及明显干湿啰音。心、腹无明显异常体征。辅助检查:血常规及血气、心肌肌钙蛋白均正常。血生化:总蛋白56 g·L-1, 清蛋白23.4 g·L-1。入院胸部X线示:左侧膈疝,左侧少量胸腔积液,胃肠胀气。B超示:双侧胸腔积液(左、右侧胸腔无回声区宽径分别是2.6和1.9 cm)。心脏彩超无异常。入院第2天在B超定位下行左侧胸腔穿刺及闭式胸腔引流术。引流液呈乳糜样,胸腔积液呈现:黄色,混浊,李凡他实验(+),总蛋白19.5 g·L-1 ,清蛋白8.2 g·L-1,乳酸脱氢酶68 U·L-1,腺苷脱氨酶3 U·L-1,红细胞计数40×106·L-1,有核细胞计数550×106·L-1,嗜中性粒细胞比例10%,淋巴细胞比例80%,巨噬细胞比例10%,嗜酸粒细胞比例0%。诊断为新生儿先天性乳糜胸。采用头孢哌酮钠/他唑巴坦钠(商品名:普妥利康,海口奇力制药股份有限公司,批准文号:国药准字H20070234)预防感染,补充白蛋白及禁食3 d、肠外营养等治疗,入院19 d胸腔持续引流出乳糜样液体,每天5~150 mL,平均25 mL·d-1,于第20天于胸腔内注射注射用A群链球菌(商品名:沙培林,山东鲁抗医药集团鲁亚有限公司生产,批准文号:国药准字S19980002)0.2 KE +0.9%氯化钠注射液2 mL,之后再未引流出液体(入院后患儿胸腔积液引流量及喂养情况变化见图1),第21天拔除胸腔引流管,第28天复查胸部X线无异常及胸腔B超提示双侧胸腔未见明显液性暗区,痊愈出院。综合患儿治疗结局如下:呼吸机使用时间0 d,住院时间28 d,胸腔引流时间19 d,禁食时间3 d,恢复全肠道饮食时间25 d。

例2,患儿,女,出生10 min。因“产前10 d B超提示右侧胸腔积液”入院。患儿,G4P2G39+3周, 出生体质量3.4 kg,因“瘢痕子宫”行剖宫产出生。APGAR评分不详,出生一般情况尚可,无发热、咳嗽,无呕吐等。体检:体温36.8 ℃,呼吸46次·min-1,血压60/40 mmHg,体质量3.4 kg,精神反应好,哭声响亮,前囟平软,口周无发绀。呼吸急促,三凹征阳性。肺部呼吸运动度对称,双肺听诊呼吸音清,右侧呼吸音较左侧低,无明显干湿啰音。心腹无异常。辅助检查:血常规及血气无明显异常。血生化:清蛋白34.6 g·L-1,球蛋白15.1 g·L-1,心脏彩超无异常。胸部X线:右肺野密度均匀升高,心影左移。左膈面可见,右膈面消失。胸腔B超示:右侧胸腔积液(右侧胸腔肩胛线第8~9肋间可见无回声区,最大前后径为2.7 mm)。入院第2天行右侧胸腔穿刺术及闭式引流术,胸腔积液检测结果示:黄色,混浊,李凡他实验(+),总蛋白31.7 g·L-1 ,清蛋白23.9 g·L-1,乳酸脱氢酶210 U·L-1,腺苷脱氨酶2 U·L-1,红细胞计数120×106·L-1,有核细胞计数8 320×106· L-1,嗜中性粒细胞比例0%,淋巴细胞比例88%,巨噬细胞比例2%,嗜酸粒细胞比例0%。诊断为新生儿先天性乳糜胸。入院予以鼻导管吸氧,头孢哌酮钠/他唑巴坦钠(商品名:普妥利康,海口奇力制药股份有限公司,批准文号:国药准字H20070234)预防感染,5%葡萄糖注射液喂养及肠外静脉营养治疗。入院4 d内胸腔持续引流出乳糜样液体,每天6~270 mL,平均107 mL·d-1,于第5天加用0.9%的氯化钠注射液5 mL+注射用A群链球菌(商品名:沙培林,山东鲁抗医药集团鲁亚有限公司生产,批准文号:国药准字S19980002)0.5 KE胸腔内注入,此后胸腔引流量迅速减少(入院后患儿胸腔引流量及喂养情况变化见图2),第6天停止输氧。第11天拔除引流管。第17天复查胸部X线无异常及胸腔B超示双侧胸腔未见明显液性暗区,治愈出院。综合患儿治疗结局如下:呼吸机使用时间0 d,住院时间17 d,胸腔引流时间9 d,禁食时间1 d,恢复全肠道饮食时间13 d。

图1 病例1住院期间胸腔引流量及肠道喂养量变化

Fig.1 Variation of the volume of chest drainage and intestinal feeding amount for case 1 during hospitalization

图2 病例2住院期间胸腔引流量及肠道喂养量变化

Fig.2 Variation of the volume of chest drainage and intestinal feeding amount for case 2 during hospitalization

2 文献复习
2.1 资料来源

以“(注射用A群链球菌or A群链球菌制剂)AND(乳糜胸or乳糜腹)”为检索词检索万方数据库,发现1篇文献使用注射用A群链球菌成功治疗难治性新生儿乳糜胸2例。以“(OK-432 or sapylin or picibanil)AND(chylothorax)”为检索词检索PubMed数据库,检索时间截止2015年6月,共检索出文献44篇,经过阅读摘要后剔除与本研究目无关以及重复发表的文献,最后有37篇报道,其中注射用A群链球菌治疗成人乳糜胸20篇,产前治疗胎儿乳糜胸13篇,出生后治疗新生儿先天性乳糜胸的报道有4篇共5例。

2.2 基本特征

注射用A群链球菌治疗成人乳糜胸48例,绝大多数效果较好。但注射用A群链球菌用于产前治疗胎儿乳糜胸的报道中有16例胎儿死亡,这部分胎儿均伴有基因或染色体异常。注射用A群链球菌用于新生儿乳糜胸的5篇报道中患儿7例,均是在常规应用胸腔引流术或奥曲肽治疗无效,且乳糜漏达3~4周以上时后才使用注射用A群链球菌进行胸膜固定术治疗,6例效果显著,其中有2例新生儿在胸膜腔注射注射用A群链球菌后1周内出现轻度的发热,余均未出现其他明显的不良反应。

3 讨论

先天性乳糜胸是新生儿胸腔积液最常见的原因[9],病因尚不清楚,可能与淋巴管发育异常有关[10],多见于足月儿。一般在新生儿期起病,严重者在宫内或出生时即有表现,如胎儿水肿、胸腔积液、呼吸困难等[11]。先天性乳糜胸诊断依据:①出生28 d内发病,最迟不超过2个月;②存在胸腔积液;③胸腔积液特点为无菌性液体,外观呈牛奶样,乳糜试验阳性,淋巴细胞比例≥80%,或三酰甘油水平>1.24 mmol· L - 1 12 。先天性乳糜胸易并发其他先天性疾病,如先天性心脏病、Turner综合征、21三体综合征、Noonan综合征等[13-14],Al-TAWIL等[12],19例先天性乳糜胸患儿中11例并发其他疾病,以先天性心脏病最多(8例)。产前超声检查有利于严重先天性乳糜胸的产前诊断[15]。本病由于乳糜液的大量丢失常导致大量蛋白质、脂肪、淋巴细胞及HCO3-的丢失而出现营养不良、低丙种球蛋白血症、细胞免疫缺陷及代谢性酸中毒等疾病,并引起感染的风险增高,所以控制乳糜液产生及早日拔管也极为重要[16]

先天性乳糜胸的治疗包括产前治疗及出生后治疗。产前治疗主要为胸腔羊膜腔引流或注射用A群链球菌胸腔固定术以防止肺发育不良[8,17]。出生后治疗方案有保守治疗及手术治疗。保守治疗包括低脂高蛋白饮食、胃肠外静脉营养、胸腔引流等,手术治疗是采用化学胸膜固定术。对于重症病例建议严格禁食禁水,并行全肠道外营养(TPN),也有报道建议用富含中链三酰甘油的深度水解奶喂养[18]。文献报道,80%先天性乳糜胸患儿可经保守治疗而治愈[12]。目前没有指南明确提出先天性乳糜胸的有效治疗策略,有学者推荐闭式引流>2周或胸腔积液引流量大50 mL·kg-1·d-1时,可考虑手术治疗,即采取化学胸膜固定术[19-21]。本文2例均为足月儿,符合先天性乳糜胸诊断标准,其中1例为产前诊断,二者都未并发其他疾病,治疗上均以5%葡萄糖溶液喂养但不能控制胸腔积液,其中有1例患儿喂食深度水解配方奶后出现乳糜液明显增多,提示单从喂养上控制脂肪的摄入仍不能快速控制病情。

奥曲肽(octreotide) 是一种合成的生长抑素类似物,具有广泛的内分泌抑制作用,抑制生长激素、生长调节素C和多种胃肠道激素,也能抑制淋巴液的产生[22],其在成人及儿童手术后所致创伤性乳糜胸的治疗中效果显著[23-25],故静脉滴注奥曲肽常被建议作为先天性乳糜胸经保守治疗无效的二线用药[26-28]。CANNIZZARO等[29]报道13例乳糜胸患儿,应用奥曲肽后6例效果良好,避免手术。然而,DAS等[27]研究发现关于奥曲肽治疗新生儿乳糜胸疗效的研究尚无随机对照试验。由于奥曲肽主要是通过收缩内脏血管及抑制消化液的分泌从而减少胸导管的淋巴流量而达到治疗的效果,所以在新生儿中其最大的危害可能会导致新生儿坏死性小肠结肠炎的发生[30]。奥曲肽剂量也可由起始0.5 μg·kg-1·h-1逐渐增加到10 μg·kg-1·h-1 [31-32].

化学胸膜固定术指采用化学制剂注入胸腔使胸膜发生化学炎症而粘连,从而使胸导管闭合而阻止乳糜漏出。国内常用红霉素[31,33]。也有采用阿奇霉素胸腔内注射有效治疗1例乳糜胸的报道[34]。但红霉素及阿奇霉素可能会引起疼痛、胸膜反应严重等不良反应。注射用A群链球菌主要的作用机制是调节机体免疫功能,提高T细胞和NK细胞的活性,并促进免疫细胞释放炎症介质,包括白细胞介素6(IL-6)、肿瘤坏死因子(TNF)等,同时引起局部的无菌性炎症,造成胸膜粘连、增厚,从而阻止胸液渗出达到治疗的目的[35]。注射用A群链球菌的不良反应有疼痛、发热、过敏,轻度、暂时性的血红蛋白和红细胞减少、白细胞增多及肝酶增高的情况[36]。国外报道,注射用A群链球菌广泛用于儿童胸腔术后并发的乳糜胸及囊性淋巴管畸形的治疗,效果显著[2-4]。也有注射用A群链球菌用于胎儿乳糜胸的治疗的报道[5-8]。MATSUKUMA等[32]报道2例奥曲肽治疗无效的新生儿先天性迁延性乳糜胸,采用注射用A群链球菌胸腔注入后疗效显著。KIM等[37]报道注射用A群链球菌成功治疗2例早产儿先天性乳糜胸。国内报道1例注射用A群链球菌用于成人特发性乳糜胸[37]。可快速有效地控制乳糜液的漏出,无明显不良反应[38]。本文2例患儿均在征求患儿父母同意的情况下应用注射用A群链球菌,分别于病程的第20天和第5天于胸膜腔内注入注射用A群链球菌,均于用药后第2天乳糜液迅速减少、1周内拔管,极大的缩短住院时间,用药后均未出现发热、皮疹、激惹及其他不良反应。注射用A群链球菌参考推荐剂量为0.1 KE·mL-1,用前需做青霉素皮试[7]

综上所述,注射用A群链球菌对于新生儿是一种相对安全的药物,可作为治疗新生儿先天性乳糜胸的一种有效手段。在新生儿乳糜胸保守治疗过程中如胸腔闭式引流时可早期联用注射用A群链球菌,可提高乳糜胸治愈率,促进早日拔管,降低感染风险及缩短静脉营养及住院时间。但本文仅2例报告,因此需要进一步前瞻性、多中心大样本的随机对照及长期随访的研究资料来评估其在新生儿乳糜胸治疗的安全性及有效性。文献推荐新生儿或胎儿剂量为0.1 KE(1 KE注射用A群链球菌加入0.9%氯化钠注射液10 mL稀释)注射入胸腔[7]

The authors have declared that no competing interests exist.

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Chylothorax is a rare congenital condition associated with significant perinatal mortality and morbidity. Previous treatments with repeated thoracocentesis or thoracoamniotic shunting were technically demanding, and associated with significant procedure-related complications and neonatal complications. Here we report the first successful case in Hong Kong treated by a simple and effective intervention, namely pleurodesis with OK-432, in a fetus presenting at 20 weeks of gestation with bilateral pleural effusion.
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Chylothorax is the accumulation of chyle in the pleural space, as a result of damage to the thoracic duct. Chyle is milky fluid enriched with fat secreted from the intestinal cells and lymphatic fluid. Chylothorax in children, is most commonly seen as a complication of cardiothoracic surgery but may occur in newborns or conditions associated with abnormal lymphatics. The diagnosis is based on biochemical analysis of the pleural fluid, which contains chylomicrons, high levels of triglycerides and lymphocytes. Investigations to outline the lymphatic channels can prove helpful in some cases. Initial treatment consists of drainage, dietary modifications, total parenteral nutrition and time for the thoracic duct to heal. Somatostatin and its analogue octreotide may be useful in some cases. Surgery should be considered for patients who fail these initial steps, or in whom complications such as electrolyte and fluid imbalance, malnutrition or immunodeficiency persist. Surgical intervention may be attempted thoracoscopically with repair or ligation of the thoracic duct.
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To describe the clinical course of patients with congenital chylothorax focusing on infectious complications. Congenital chylothorax is a common manifestation of non-immune hydrops fetalis (NIHF). The drainage of chyle leads to loss of cellular and plasmatic factors that influence the patient's immune response and increase the risk of infections.In a retrospective analysis of 24 preterm infants with NIHF treated between 1998 and 2002, congenital chylothorax was diagnosed in 7 patients.All 7 patients were treated conservatively with pleural drainage over a median period of 22 d (range 10-36 d). Lymphopenia was found in all patients (median of minimal lymphocyte counts 285/microl, range 80-770). The nadir was on day 5 (2-6 d). Lymphopenia lasted for 12 d median (range 4-39 d) and was significantly correlated with the duration of lymph drainage (p = 0.001). Cell-surface analysis of peripheral blood lymphocytes was performed in two patients. Both patients had a decreased number of total T cells. Four out of seven (57%) patients developed nosocomial infections. This incidence of nosocomial infections in patients with congenital chylothorax is about three times higher than that in other neonatal patients. None of the children suffered from fungal or viral infection. Although there was a very high incidence of infections, no correlation between lymphopenia and the occurrence of infections could be shown.Drainage of congenital chylothorax results in the loss of lymphocytes and bears a high risk of infections.
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The ability to recognize, understand, and treat pleural effusions in the pediatric population is important for pediatric health care providers. The topic of pleural effusions has been extensively studied in the adult population. In recent years, these studies have extended into the pediatric population. This review describes pleural effusions in detail, including the different types and underlying pathophysiology. We then go on to provide a comprehensive review of the recent literature regarding the diagnosis and treatment of pleural effusions in the pediatric population.
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Abstract The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.
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Abstract Neonatal chylothorax results from the accumulation of chyle in the pleural space and may be either congenital or an acquired condition. Congenital chylothorax is most likely due to abnormal development or obstruction of the lymphatic system. It is often associated with hydrops fetalis. It can be idiopathic or may be associated with various chromosomal anomalies including Trisomy 21, Turner syndrome, Noonan syndrome, and other genetic abnormalities. Congenital pulmonary lymphangiectasia and generalized lymphangiomatosis have also been reported to be associated with congenital chylothorax. Several case reports indicate that congenital chylothorax can recur in subsequent offspring, suggesting a possible underlying genetic etiology. It is important to identify infants with chylothorax, as there are specific issues that need to be addressed in the management of these patients. We present a case of newborn with trysomy 21 (trisomy 21 was diagnosed antenatally by amniocentesis with support of Association "Perinatology"), who developed moderate Respiratory Distress Syndrome, chest X-ray and US reveal pleural effusion on right side rapid intervention was made before deterioration, requiring intensive life-saving measures. In the neonate, chylous effusion is not a common cause of pleural effusions. It is characterized as an exudate because of the high protein and lipid content once the infant is fed. The fluid will be clear/yellow to slightly cloudy in the unfed state and will quickly become milky following feeding, as chylomicrons appear in the fluid. Lymphocytes predominate in the differential cell count of chyle. The volume of fluid output can be high, and management can be challenging. We review the common manifestations of congenital chylotoraxes and emphasize the importance of early diagnosis and intervention in preventing devastating outcomes from this condition.
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Fetal is a rare condition that occurs sporadically or can be associated with abnormal karyotype or structural . We report a unique case of fetal congenital bilateral associated with mosaicism 47,/46,XX. A female fetus affected by massive bilateral and ascites was diagnosed at 34(+1) weeks of . Previous ultrasonographic exams were completely normal. Immune causes of were excluded. Elective cesarean section was performed soon after bilateral thoracocentesis. The analysis of drained pleural fluid revealed its lymphatic nature. The fetal karyotyping, performed on chorionic villi at the 11th week, had shown mosaicism 47,/46,XX, later confirmed in the newborn's blood. We hypothesized that may be part of the phenotypic spectrum of 47 XXX karyotype and we suggest an ultrasound follow-up of the fetus at closer intervals than the routine timing for this condition, even if it is not usually characterized by severe phenotypic features.
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Abstract The objective of this paper is a retrospective study of all infants treated for congenital chylothorax at the Royal Children's Hospital (RCH), Melbourne, Australia and King Fahad National Guard Hospital (KFNGH), Riyadh, Kingdom of Saudi Arabia. The charts of all infants with congenital chylothorax admitted to RCH over a period of 13 years, June 1982-August 1994, and admissions to KFNGH over a 7-year period, June 1992-August 1998 inclusive, were reviewed including management outcome and complications. There were 19 infants, 13 from RCH and 6 from KFNGH; 11 females and 8 males. Three infants were managed antenatally. Fifteen infants presented immediately after birth. Seven were born with hydrops fetalis, 6 infants had syndromes and 10 infants were born prematurely. Regular infant feeding formula and/or breast milk were used successfully in 12 infants, while in 7 infants medium chain triglycerides (MCT) rich formula was used. Sixteen infants were mechanically ventilated with 75% of them ventilated for < or = 28 days. Fifteen infants received total parenteral nutrition (TPN), and in 80% for < or = 32 days. Hydropic infants had longer duration of mechanical ventilation and hospital stay with mean (range) of 33.9 (3-120) and 115 (23-225) days, respectively, compared with 18 (1-62) and 34.3 (14-88) days for nonhydropic infants. Five infants underwent surgery with failure in four. Sepsis and bronchopulmonary dysplasia were the main complications. The survival rate was 100% regardless of the mode of therapy. The prognosis of Isolated congenital chylothorax in term, and preterm infants is good even in the presence of hydrops. Breast milk and/or regular infant feeding formula should be used initially before proceeding to MCT-rich formula, which may be necessary in some cases. Surgery should be considered if conservative management of congenital chylothorax fails after 4-5 weeks.
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[16] ERGAZ Z,BAR-OZ B,YATSIV I,et al.Congenital chylothorax: clinical course and prognostic significance[J].Pediatr Pulmonol,2009,44(8): 806-811.
Abstract Objective To determine the underlying etiology, associated malformations, clinical course, and prognostic significance of congenital chylothorax. Study design A retrospective analysis of 11 neonates admitted to our neonatal intensive care unit with congenital chylothorax between January 2000 and June 2008. The post-discharge clinical and developmental course was evaluated by a telephone survey performed in July 2008. Results Antenatal diagnosis was established in 9 out of 11 infants by ultrasound examination; 5 had intrauterine pleural drainage. Eight infants had either structural or chromosomal abnormalities. The postnatal treatment included mechanical ventilation, drainage of pleural fluid and feeding with enriched medium chain triglyceride formula. Somatostatin was administered in one case. Six patients developed nosocomial infections. Two patients died after resolution of the chylothorax from deteriorating renal failure. Seven patients were traced for follow up and six of them achieved age appropriate developmental milestones. Conclusion The recovery from chylothorax and future prognosis were dependent on the underlying etiology. Chylothorax was often a secondary event, with apparently favorable clinical and developmental prognosis when the underlying or/and associated condition was treatable. Pediatr Pulmonol. 2009; 44:806鈥811. 漏 2009 Wiley-Liss, Inc.
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[17] MIYOSHI T,KATSURAGI S,IKEDA T,et al.Retrospective review of thoracoamniotic shunting using a double-basket catheter for fetal chylothorax[J].Fetal Diagn Ther,2013,34(1): 19-25.
Abstract OBJECTIVE: From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device. METHODS: A retrospective single-center study was performed in 35 cases of fetal chylothorax. RESULTS: There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting. CONCLUSION: Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses. Copyright 漏 2013 S. Karger AG, Basel.
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[18] GUPTA V,MAHENDRI N V,TETE P,et al.Skimmed milk preparation in management of congenital chylothorax[J].Indian Pediatr,2014,51(2): 146-148.
Treatment for congenital chylothorax is based on adequate drainage of the pleural fluid and total parenteral nutrition followed by re-establishment of feeds using medium-chain-triglycerides based milk formulas which are expensive and not easily available.Two newborns (one term and one preterm) with congenital chylothorax.Skimmed milk preparation for enteral nutrition to provide high protein and low fat diet.Successful resolution of chylothorax.Skimmed milk preparation may be used for enteral nutrition of babies with congenital chylothorax where other feeding alternatives or commercial formulas are either not successful or are not available.
DOI:10.1007/s13312-014-0333-z      PMID:24632698      Magsci     URL    
[本文引用:1]
[19] SHIH Y T,SU P H,CHEN J Y,et al.Common etiologies of neonatal pleural effusion[J].Pediatr Neonatol,2011,52(5): 251-255.
Background: Pleural effusion is rare and includes several disease entities in the neonatal period. The aim of this study was to investigate the etiology, management, and outcome of neonatal pleural effusions.<br/>Methods: We retrospectively collected all neonates who were admitted to the neonatal intensive care unit of Chung Shan Medical University Hospital, Taichung, Taiwan, with discharge diagnosis of pleural effusion, chylothorax, hydrothorax, hemothorax, and empyema, from January 1999 to December 2009. The characteristics, etiology, management, and outcome were analyzed.<br/>Results: There were 21 patients identified, 16 males (76%) and 5 females (24%). Eight patients (38%) had primary and 13 patients (62%) had secondary etiologies. The etiologies included four parapneumonic effusions or empyema (19%); nine chylothorax (42.8%) with four congenital and five iatrogenic after thoracic surgery; three percutaneously inserted central venous catheter extravasation (14%); one umbilical venous catheter extravasation (4.7%); three hydrops fetalis (14%); and one congestive heart failure (4.7%). Fifteen patients (71%) needed chest tube placement. Conservative management with complete cessation of enteral feedings and use of total parenteral nutrition followed with infant formula containing medium-chain triglyceride was successful in six of the patients (67%) with chylothorax. There were two patients (22%) with chylothorax who received somatostatin administration; one was successful and the other one failed. Thoracic duct ligation was performed uneventfully in two patients with acquired chylothorax. There were three mortalities (14.3%) in this study, which were related to causes other than pleural effusion.<br/>Conclusions: Pleural effusions in the neonatal stage may result from chylothorax, hydrops fetalis, extravasation of percutaneously inserted central venous catheter, parapneumonic effusion, congestive heart failure, or other less frequently occurring conditions. Diagnostic chest tap is required for subsequent management. Good outcome is the rule except in hydrops fetalis, which carries high mortality rate. Copyright (C) 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.
DOI:10.1016/j.pedneo.2011.06.002      Magsci    
[本文引用:1]
[20] CLEVELAND K,ZOOK D,HARVEY K,et al.Massive chylothorax in small babies[J].J Pediatr Surg,2009,44(3): 546-550.
Surgery has a definitive role in the care of small babies with massive chylothorax. Daily output exceeding 50 mL/kg per day with no or minimal response to 3 days of maximal medical therapy may indicate a potential therapeutic benefit of surgery.
DOI:10.1016/j.jpedsurg.2008.08.008      PMID:19910723820519302856      Magsci     URL    
[本文引用:0]
[21] BEGHETTI M,LA SCALA G,BELLI D,et al.Etiology and management of pediatric chylothorax[J].J Pediatr,2000,136(5): 653-658.
To determine the incidence and etiology of chylothorax and to assess our therapeutic management approach.We reviewed 51 patients diagnosed with chylothorax over a 12-year period. Cause, interval between operation and diagnosis, duration of chylothorax, and total volume loss per weight were recorded.Chylothorax was diagnosed in 46 children after cardiothoracic surgery, giving an incidence of 2.5% (46/1842); in 1 child chylothorax occurred after chest trauma, and in 4 the chylothorax was congenital or a manifestation of lymph angiomatosis. Three etiologic groups were identified: group 1, direct injury to the thoracic duct (33/51 = 65%); group 2, thrombosis and/or high venous pressure in the superior vena cava (14/51 = 27%); and group 3, congenital (4/51 = 8%). Conservative treatment was the only treatment in 80% of the patients. Surgical procedures consisted of 4 ligations of the thoracic duct, placement of 7 pleurodesis shunts, and placement of 2 pleuroperitoneal shunts. Patients in groups 2 and 3 were at higher risk for failure of conservative treatment (P <. 005). Longer duration of chylothorax and higher volume of drainage were present in group 2 compared with group 1 (P <.01).Conservative treatment was successful in 80% of the patients with our management approach. Prevention, early recognition, and treatment of potential complications, such as superior vena cava thrombosis or obstruction, may further improve success of conservative treatment. Congenital chylothorax seems different and may require a specific approach.
DOI:10.1067/mpd.2000.104287      PMID:10802499      URL    
[本文引用:1]
[22] AU M,WEBER T R,FLEMINGl R E.Successful use of somatostatin in a case of neonatal chylothorax[J].J Pediatr Surg,2003,38(7): 1106-1107.
A 2-week-old infant status postrepair of gastroschisis had spontaneous bilateral chylothoraces necessitating thoracostomy drainage. Voluminous chylous drainage persisted despite cessation of enteral feedings. On administration of the somatostatin analogue octreotide, pleural drainage diminished markedly and ceased entirely within 4 days. These results, along with reported successes in treatment of chylothorax after thoracic surgery, support the prospective investigation of somatostatin use in problematic chylothorax.
DOI:10.1016/S0022-3468(03)00205-7      PMID:12861552      URL    
[本文引用:1]
[23] FUJITA T,DAIKO H.Efficacy and predictor of octreotide treatment for postoperative chylothorax after thoracic esophagectomy[J].World J Surg,2014,38(8): 2039-2045.
Postoperative chylothorax sometimes follows thoracic esophagectomy for esophageal cancer. The effectiveness of octreotide treatment for it and factors that predict its response are unclear. This study aimed to evaluate the efficacy of octreotide for treating postoperative chylothorax following thoracic esophagectomy for esophageal cancer and factors that might predict successful treatment and allow chest drain removal.<br/>We assessed 521 consecutive patients who underwent thoracic esophagectomy for esophageal cancer to investigate the efficacy of octreotide for postoperative chylothorax. Among those with postoperative chylothorax, one group (group A) underwent conservative management, and the other (group B) was treated conservatively with added octreotide administration. We evaluated the clinical outcomes after octreotide administration and assessed the factors associated with successful treatment.<br/>Among the 521 patients, 20 (3.8 %) developed postoperative chylothorax: five in group A and 15 in group B. Two of the five (20 %) group A patients and 13 of the 15 (86.6 %) group B patients were treated successfully (p = 0.03). Factors significantly associated with treatment failure were (1) chest drain output of > 1,000 ml/day before treatment (p = 0.04); (2) no reduction in chest drainage by the second day of treatment (p = 0.016); (3) chest drainage of > 1,000 ml/day through the second day of treatment (p = 0.006).<br/>For patients with esophageal cancer who undergo thoracic esophagectomy, octreotide can be an effective treatment for postoperative chylothorax.
DOI:10.1007/s00268-014-2501-7      Magsci     URL    
[本文引用:1]
[24] WHITE S C,SECKELER M D,MC CULLOCH M A,et al.Patients with single ventricle anatomy may respond better to octreotide therapy for chylothorax after congenital heart surgery[J].J Card Surg,2014,29(2): 259-264.
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[25] PARAMES F,FREITAS I,FRAGATA J,et al.Octreotide--additional conservative therapy for postoperative chylothorax in congenital heart disease[J].Rev Port Cardiol,2009,28(7-8): 799-807.
INTRODUCTION: is a rare but serious postoperative condition in children with . Conventional medical treatment consists of specific long-term dietary modification, and surgical reintervention, such as lymphatic duct ligation, may be indicated in refractory cases. In recent years, an additional conservative treatment, octreotide, a synthetic analog of somatostatin, has been used in management of congenital and postoperative .: The objective of this work was to analyze the efficacy and safety of this treatment for after congenital heart surgery. We reviewed the records of sixteen patients with after surgery for between January 1999 and December 2007, and collected the following data: demographic information; type of surgical procedure; onset, duration and management of and treatment; and duration of hospital stay. To analyze efficacy we compared these parameters in children receiving conventional treatment only with those receiving octreotide. To analyze safety we compared the adverse effects of both treatments. Octreotide was administered at a dose of 4 to 10 microg/kg/hour, with monitoring of side effects.: The incidence of in our population was 1.6%. It occurred more often after Glenn and Fontan procedures (8 patients). Octreotide was begun three days after diagnosis of and continued for a median of seventeen days (ranging from 4 to 26 days), until complete resolution. Side effects were frequent (in 3 of the 8 patients) but of no clinical relevance. All patients responded to the therapy and there was no indication for further surgical intervention.: Octreotide is safe and effective in the treatment of postoperative in children with . It is a useful adjunctive therapy to the conventional treatment of this complication.
PMID:19894659      URL    
[本文引用:1]
[26] JARIR R A,RAHMAN S U,BASSIOUNY I S.Use of octeriotide in the management of neonatal chylothorax secondary to repair of congenital diaphragmatic hernia: a report of two cases and review of literature[J].J Clin Neonatol,2012,1(2): 91-95.
Chylothorax, a known complication of surgery for Congenital Diaphragmatic hernia, can sometimes be resistant to treat. Octeriotide (Somatostatin analogue) can be useful in this situation. However, the dose and schedule of Octeriotide therapy in neonates is not well established. We report two cases of resistant chylothorax following surgery for congenital diaphragmatic hernia which were successfully managed by using an escalating infusion of octeriotide. The literature on the subject is also reviewed.
DOI:10.4103/2249-4847.96767      PMID:3743138      URL    
[本文引用:1]
[27] DAS A,SHAH P S.Octreotide for the treatment of chylothorax in neonates[J].Cochrane Database Syst Rev,2010(9): D6388.
[本文引用:1]
[28] 刘振球,华子瑜,陈贻骥,.奥曲肽治疗新生儿先天性乳糜胸[J].中国当代儿科杂志,2013,15(12): 1093-1095.
新生儿乳糜胸是由于先天性和获得性因素导致淋巴液漏入胸腔引起 [1],是造成新生儿呼吸困难的罕见疾病,却是新生儿期胸腔积液最常见的原因之一,患病率约为出生婴儿中的十万分之一,病死率可高达20%~50% [1].产前治疗主要为胸腔羊膜腔引流防止肺发育不良.生后治疗方案一直有争论,分保守治疗和手术治疗[2].保守治疗包括含有中链甘油三酯的低脂高蛋白 饮食、全胃肠外营养、胸腔引流、呼吸支持、化学或机械的胸膜固定术.手术治疗包括胸腔镜胸膜固定术、胸膜腹膜分流术、胸导管结扎和胸膜部分切除术.
DOI:10.7499/j.issn.1008-8830.2013.12.013      Magsci     URL    
[本文引用:1]
[29] CANNIZZARO V,FREY B,BERNET-BUETTIKER V.The role of somatostatin in the treatment of persistent chylothorax in children[J].Eur J Cardiothorac Surg,2006,30(1): 49-53. [本文引用:1]
[30] LAJE P,HALABY L,ADZICK N S,et al.Necrotizing enterocolitis in neonates receiving octreotide for the management of congenital hyperinsulinism[J].Pediatr Diabetes,2010,11(2): 142-147.
The analog was used for the first time in the treatment of an infant with in 1986. Since then, it is commonly used in the management of congenital hyperinsulinemic . Despite a wide variety of potential adverse reactions, is generally well tolerated. It has been extensively demonstrated that reduces the splanchnic blood flow in a dose-dependent manner, affecting the entire gastrointestinal tract, and some concern has been recently raised regarding the potential implications of this effect in the development of in neonates receiving for the management of . The aim of this report is to present a series of patients treated at our institution in which we observed this association, and review the current related literature.
DOI:10.1111/j.1399-5448.2009.00547.x      PMID:19558634      URL    
[本文引用:1]
[31] 杨祖钦,曹小敏,黄玉梅,.新生儿乳糜胸7例临床诊治分析[J].中国新生儿科杂志,2014,29(6): 405-407.
目的分析新生儿乳糜胸的临床特点。方法对2005年1月至2013年6月本院新生儿科收治的 新生儿乳糜胸病例进行回顾性研究,分析患儿病史、临床表现、相关检查、治疗方法、疗程、治疗效果及不良反应。结果研究期间共收治7例新生儿乳糜胸患儿,生 后40 min至13天起病,其中1例于产前超声即提示有胸腔积液。患儿均有气促、发绀、呼吸困难进行性加重、患侧胸廓饱满及肺部听诊呼吸音减低,5例有肺部湿啰 音。经胸部X线、胸部CT或胸部超声证实胸腔积液,左侧4例,右侧2例,双侧1例。胸水白细胞(150~72 000)×10^6/L,乳糜实验均阳性,血总蛋白、白蛋白均明显降低。7例均予胸腔闭式引流,部分患儿予奥曲肽、红霉素、沙培林治疗,疗程7~48天。 5例患儿完全吸收出院;1例好转出院,3个月后随访完全吸收;1例因败血症、肺炎死亡。结论新生儿乳糜胸应早期予以胸腔闭式引流,并联合使用红霉素针胸腔 注射和奥曲肽针静脉滴注。难治性乳糜胸经家属同意后可用沙培林治疗。
[本文引用:2]
[32] MATSUKUMA E,AOKI Y,SAKAI M,et al.Treatment with OK-432 for persistent congenital chylothorax in newborn infants resistant to octreotide[J].J Pediatr Surg,2009,44(3): 37-39.
Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. We are reporting the use of OK-432 for treatment of prolonged idiopathic congenital chylothorax in 2 newborn infants who failed to respond to conservative medical therapy, including octreotide injection.
DOI:10.1016/j.jpedsurg.2008.12.008      PMID:19302843      URL    
[本文引用:2]
[33] 杨建生,吴本清,贺务实,.7例新生儿乳糜胸的临床分析[J].中华全科医学,2011,9(8): 1175-1176.
目的分析新生儿乳糜胸的原因、临床过程及治疗效果并复习相关文献。方法对2009~2010 年收住深圳市人民医院新生儿重症监护室的7例乳糜胸患儿进行回顾性分析。详细分析病史及相关检查结果明确病因,并对其采取的治疗方法包括:一般治疗方法、 化学胸膜固定术(胸腔内注入红霉素)以及奥曲肽持续滴入的治疗时间、疗程、效果及副作用进行分析。结果7例患儿中3例为创伤性乳糜胸,4例为先天性乳糜 胸。其中3例创伤性乳糜胸和1例先天性乳糜胸患儿在一般治疗加用化学胸膜固定术治疗后痊愈;2例大量及反复的先天性乳糜胸患儿在其基础上加用生长抑素类似 物奥曲肽后痊愈,且没有发现任何副作用;1例患儿因合并有严重的合并症,家长放弃治疗。结论新生儿乳糜胸为新生儿胸腔积液的常见病因之一;随着中心静脉营 养的开展,应注意新生儿创伤性乳糜胸的发生;对于新生JL-%糜胸的治疗,首先应选择保守的治疗措施,使用一般治疗加用化学胸膜固定术(胸腔内注入红霉 素)有效,对于难治性及反复的乳糜胸患儿在其基础上加用生长抑素及其类似物奥曲肽治疗效果明显。
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[本文引用:1]
[34] 唐本玉,朱顺叶,钟晓冰,.新生儿乳糜胸二例[J].新医学,2014,46(10): 695-698.
新生儿乳糜胸是由胸导管或胸腔淋巴管破裂使淋巴液漏入胸腔所致,可引起严重呼吸困难及营养、免疫障碍,病死率较高。该文报道2例新生儿乳糜胸病例,2例均以呼吸困难、胸腔积液为主要临床表现,胸腔积液淋巴细胞比率均不低于0.8。1例经胸腔穿刺引流术联合一般治疗治愈,1例经阿奇霉素胸膜固定术治愈。2例成功诊治的经验提示临床医师应提高对该疾病的诊治水平,早诊断、及时处理有助于提高该病患儿的生存率。
[本文引用:1]
[35] 林辉斌,苏伟强,陈虹,.细导管引流及注入沙培林治疗恶性胸腔积液的疗效[J].广东医学,2005,26(5): 634-635.
目的观察和评价深静脉导管胸腔内置管引流及注入沙培林治疗恶性胸积液的疗效和安全性。方法将58例肺癌并胸积液患者用B超定位后予留置深静脉导管充分引流后,每隔3天予注入不同剂量的沙培林,共2~3次。结果58例患者总有效率为81%。主要不良反应为不同程度的发热及胸痛。结论深静脉导管胸腔内置管引流后注入沙培林治疗恶性胸积液是有效的,且操作安全,不良反应较轻,值得临床推广。
[本文引用:1]
[36] OGITA S,TSUTO T,NAKAMURA K,et al.OK-432 therapy in 64 patients with lymphangioma[J].J Pediatr Surg,1994,29(6): 784-785.
Intralesional injection of OK-432 was employed to treat 64 lymphangiomas between 1986 and 1992. This was used as primary therapy for 46 lesions (group A), as treatment following incomplete surgical removal in 14 (group B), and as therapy after failure of bleomycin in 4 (group C). In group A (n = 46), total shrinkage of the lesion, without serious complications, was noted in 23; there was marked shrinkage in 8, slight shrinkage in 12, and no response in 3. Of the cystic lesions (n = 24), significant shrinkage occurred in 22; of the cavernous lesions (n = 22), only 9 improved after treatment. In groups B (n = 14) and C (n = 4) there was significant clinical improvement occurred in 5 and 2, respectively. No recurrence was noted during follow-up (6 to 87 months). The only side effects were fever lasting 2 to 4 days and a local inflammatory reaction of 3 to 7 days' duration. The local inflammation did not cause any damage to the overlying skin and did not lead to scar formation. These data suggest that intralesional injection of OK-432 is effective treatment for lymphangiomas and should be considered as the primary method of treatment.
DOI:10.1016/0022-3468(94)90370-0      PMID:8078021      URL    
[本文引用:1]
[37] KIM J E,LEE C,PARK K I,et al.Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion[J].Korean J Pediatr,2012,55(5): 177-180.
OK-432 (picibanil) is an inactivated preparation of Streptococcus pyogenes that causes pleurodesis by inducing a strong inflammatory response. Intrapleural instillation of OK-432 has recently been used to successfully treat neonatal and fetal chylothorax. Here we report a trial of intrapleural instillation of OK-432 in two preterm infants who were born with hydrops fetalis and massive bilateral pleural effusion. Both cases showed persistent pleural effusion, refractory to conservative treatment, up to postnatal days 26 and 46, respectively. An average of 80 to 140 mL of pleural fluid was drained daily. In case 1, the infant was treated with OK-432 during the fetal period at gestation 28 weeks and 4 days of gestation, but showed recurrence of pleural effusion and progressed into hydrops. Within two to three days after OK-432 injection, the amount of pleural fluid drainage was dramatically decreased and there was no reaccumulation. We did not observe any side effects related to OK-432 injection. We suggest that OK-432 should be considered as a therapeutic option in infants who have persistent pleural effusion for more than four weeks, with the expectation of the early removal of the chest tube and a good outcome.
DOI:10.3345/kjp.2012.55.5.177      PMID:43291      URL    
[本文引用:2]
[38] XU Z H,WANG C F,ZHANG Y Q,et al.A case of chylothorax treated curatively with Sapylin,a streptococcus preparation[J].J Zhejiang Univ Sci B,2007,8(12): 885-887.
Chylothorax is an uncommon disease where fatty fluid accumulates within the chest cavity. Conservative management, including repeated thoracentesis or pleurodesis, seems to be suitable to most cases. Herein, we present a case of efficacious pleurodesis by intrapleural injection of Sapylin, a streptococcus preparation, for the treatment of chylothorax. A 52-year-old non-smoking female farmer was diagnosed as idiopathic chylothorax after we ruled out possible causes including chest trauma, lymphoma, lung cancer, filariasis, tuberculosis, and etc. Two-time intra-thoracic injection of 3 Klinische Einheit (KE) Sapylin achieved rapid and effective control of chylothorax with no severe side effects. Sapylin may facilitate pleurodesis by producing a strong inflammatory response.
DOI:10.1631/jzus.2007.B0885      PMID:18257122      URL    
[本文引用:1]
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关键词(key words)
A群链球菌
注射用
乳糜胸
先天性/新生儿
胸膜固定术

Streptococcus a group for...
Chylothorax
congenital/newborn infant...
Pleurodesis

作者
专晨昱
陈玲
周鸿敏

ZHUAN Chenyu
CHEN Ling
ZHOU Hongmin