TREATMENT OF POSTOPERATIVE CHYLOTHORAX BY PLEURODESIS WITH THE STREPTOCOCCAL PREPARATION OK-432

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.