J. Shimizu et al., TREATMENT OF POSTOPERATIVE CHYLOTHORAX BY PLEURODESIS WITH THE STREPTOCOCCAL PREPARATION OK-432, The thoracic and cardiovascular surgeon, 42(4), 1994, pp. 233-236
Of the 2877 patients who underwent chest surgery at our department dur
ing the 20-year period between 1973 and 1992, 9 (0.3%) developed posto
perative chylothorax. The underlying disease included primary lung can
cer in 5 patients, pulmonary metastasis in 1, invasive thymoma in 2, a
nd neuroblastoma of the posterior mediastinum in 1. For the treatment
of chylothorax, the thoracic duct was ligated in 2 patients with a hig
h volume of chylous leakage. In 6 patients treated conservatively, ear
ly pleurodesis was attained by injecting 1 to 5 doses (mean: 2.2 doses
) of the streptoccal preparation OK-432 intrathoracically; favorable r
esults were achieved. In 1 patient, the diagnosis of chylothorax was d
elayed because of postoperative pyothorax. This patient developed nutr
itional deficiency, compromised immunity, and disseminated intravascul
ar coagulation (DIC), which led to death before the chylothorax could
be treated. In principle, postoperative chylothorax should be treated
conservatively. Favorable results can be expected with the intrathorac
ic injection of OK-432 beginning at the early postoperative period to
achieve pleurodesis, combined with the prevention of nutritional defic
iency, electrolyte imbalance, and infection.