HILOTBRAKS (chylothorax; Greek chylos juice + thorax a breast) — accumulation of a lymph in a pleural cavity.
The defect in a wall of a chest channel (see) formed at operations on bodies of a chest cavity is the main reason for emergence of a chylous hydrothorax is much more rare — at the closed and opened injuries of a thorax. By data: domestic researchers, in 45 — 72% of cases the chylous hydrothorax is a consequence of intraoperative damages. The lymph can also collect in a pleural cavity at malformations of a chest channel, inflammatory and tumoral processes of various bodies of a chest cavity.
Characteristic the wedge, manifestations are caused generally by a prelum of a lung and shift of a mediastinum with symptoms of respiratory insufficiency (see) and disturbances of a hemodynamics. The symptomatology of a right-hand chylous hydrothorax is more expressed, than left-side that is caused by a bigger pliability of the left dome of a diaphragm and less expressed shift of bodies at accumulation of chyle liquid in the left pleural cavity. The diagnosis establish on the basis a wedge, yielded, results rentgenol. confirmations of availability of free liquid in a pleural cavity and shifts of a mediastinum to the opposite side, and also a characteristic type of the most chyle liquid received at a pleurocentesis. The direct limfografiya can be made for specification of the diagnosis (see). In differential diagnosis of the basic disease which caused development of a chylous hydrothorax, the crucial role is played by results of a cytologic research of the liquid received at a pleurocentesis.
Conservative treatment consists in pleurocenteses (see) or drainage of a pleural cavity (see Drainage). Duration of conservative therapy shall not exceed 2 — 3 weeks since loss of a significant amount of a lymph (see) quickly leads to exhaustion of the patient owing to loss of a large amount of electrolytes, proteins, fats and water (see the Lymphorrhea). Frequent pleurocenteses and drainage of a pleural cavity aggravate danger of infection and raise degree of operational risk.
A radical operative measure at damage of a chest channel consists in a thoracotomy (see) and bandaging of the proximal and distal ends of a channel (see. Grudnoy Canal). Operational recovery of integrity of a chest channel (sewing up of a wound, imposing of an anastomosis, etc.) did not find broad application in connection with considerable technical difficulties.
For the prevention of a recurrence it is recommended within 6 — 8 days after operation to carry out parenteral food for the purpose of reduction of a lymphopoiesis.
The forecast after operational treatment, as a rule, favorable.
However the recurrence caused by variability of a chest channel and its collaterals, lack of the valves on average department of a chest channel interfering retrograde current of a lymph is possible.
Bibliography: Vishnevsk and y A. A. and Adamyan A. A. Hirurgiya of a mediastinum, M., 1977; Zubarev R. P., Prokhorenko A. S. and 3 and in about z - to and V. N. Povrezhdeniye's N of a lymphatic channel at the closed injury of a thorax, Grudn. hir., No. 4, page 83, 1980; And yes t at l of l and I. A N. Surgical accesses to a chest channel, Hirurgiya, No. 2, page 48, 1982; Malinovsky H. N and Dubrov E. Ya. About a chylous hydrothorax at heart operations and the main vessels, Grudn. hir., No. 4, page 3, 1967; Perelman M. And, Yusupov I. A. and With e d about in and T.N. Hirurgiya of a chest channel, M., 198 4; Petrovsky B. V. Hirurgiya of a mediastinum, page 251, M., 1960. R. P. Zubarev.