Abstract
Background:Chylothorax is caused by thoracic lymphatic system injuries that leads to the lymph extravasating into the thoracic cavity. There are few reports comparing the therapeutic effects of enteral nutrition with medium-chain triglyceride and total parenteral nutrition, and the results are inconsistent. Our study aimed to research the optimum nutrition support method for chylothorax.Study design:We retrospectively reviewed 35 chylothorax patients after heart and chest surgery from 2014 to 2018, at West China Hospital of Sichuan University, among them there were 27 post-heart surgery patients. We analyzed the therapeutic effects and costs of enteral nutrition with medium-chain triglyceride (E group) and total parenteral nutrition (T group) for chylothorax.Results:The results were similar in patients with all surgeries and patients with only post heart surgery. The total cost during hospitalization in E group was higher than T group (P < 0.01), whereas the nutrition support cost was lower (P < 0.001). The length of hospital stay was longer in E group than T group (P > 0.05). Time from admission to surgery was shorter and from surgery to chylothorax diagnosis was longer in E group compared with T group. Time to resolution and removal of drainage was shorter in E group than T group but the differences were not significant.Conclusion:The therapeutic effects in enteral nutrition with medium-chain triglyceride and total parenteral nutrition had no obvious differences. Moreover, enteral nutrition with medium-chain triglyceride is safer and more economical. Therefore, we suggest that enteral nutrition with medium-chain triglyceride could be the first choice to treat postoperative chylothorax when the gastrointestinal tract function is allowed, and this result could be considered for postoperative chylous ascites.
Highlights
Chylous fistula is caused by injuries to the thoracic or abdominal duct and its branches, or larger lymphatic vessels that the lymph extravasates into the third gap
Basic clinical characteristics and outcomes of two groups of 38 postoperative chylothorax patients were included in our study and 35 were cured, and there were no other complications in all patients
In E group, 21 patients underwent heart surgery, among them, one patient failed with conservative treatment, and one patient’s drainage volume declined after conservative treatment when she transferred to another department; one patient underwent lung surgery
Summary
Chylous fistula is caused by injuries to the thoracic or abdominal duct and its branches, or larger lymphatic vessels that the lymph extravasates into the third gap. The lymph accumulation in the chest is called chylothorax, which causes severe respiratory, nutritional and immune disorders. It results in the triglyceride level of thoracic effusion to be greater than 110 mg/dL. There are few reports comparing the therapeutic effects of enteral nutrition with medium-chain triglyceride and total parenteral nutrition, and the results are inconsistent. We analyzed the therapeutic effects and costs of enteral nutrition with medium-chain triglyceride (E group) and total parenteral nutrition (T group) for chylothorax. Conclusion: The therapeutic effects in enteral nutrition with medium-chain triglyceride and total parenteral nutrition had no obvious differences. We suggest that enteral nutrition with medium-chain triglyceride could be the first choice to treat postoperative chylothorax when the gastrointestinal tract function is allowed, and this result could be considered for postoperative chylous ascites
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