• Journal of Chest Surgery
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• v.36 no.11
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• pp.883-885
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• 2003

Traditional surgical management of chylothorax refractory to conservative treatment is thoracic duct ligation through a right open thoracotomy. A new surgical procedure of ligation of the thoracic duct via extrapleural approach is presented. Its advantages are less invasive, no need of a new drainage tube, and easier to expose the thoracic duct than the conventional transthoracic approach. We experienced a new surgical method in the treatment of the chylothorax and report it with literatures.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.672-674
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• 1996

Chylothorax is a rare, but well-recognized complication of cardiothoracic surgery and operations in the region of the esophageal or aortic diaphragmatic hiatus. Especially, in nutritionally depleted patients requiring esophagectomy for benign or malignant diseases, it is a potentially life-threatening disorder that has profound respiratory, nutritional and immunologic co sequences . We have experienced a case of chylothorax after transhiatal esophagectomy in benign esophageal stricture. The diagnosis of chylothorax was confirmed after feeding through the jejunostomy tube by the change of the character of pleural effusion and high triglyceride level on the 5th postoperative day. On the thirteenth postoperative day, supradiaphragmatic thoracic duct ligation was performed through right thoracotomy. We could remove the chest tube on the 22th postoperative day, and the patient is being followed-up at out patient clinic without complications.

• Journal of Chest Surgery
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• v.37 no.5
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• pp.456-459
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• 2004

A 16 month old male infant was found with slip down state in a bath room without evidence of trauma to whole body. The infant was treated with several thoracentesis and closed drainage due to persistent right pleural effusion at other hospital and transferred to our hospital for further evaluation and treatment at July 2003. The pleural effusion was confirmed as chylothorax by chemical analysis. He was treated with parenteral feeding for 21 days. Because the amount of chest tube drainage was about 110∼210 cc/day, and could not be decreased with conservative treatment. patients underwent ligation of thoracic duct. Post-operative course was uneventful except post-op. empyema thoracis, The open drainage tube was removed at post operative 30 days, The patient was in very good condition with complete cure until post-operative 3 months.

• Journal of Chest Surgery
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• v.34 no.3
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• pp.256-259
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• 2001

식도 결핵은 아주 드문 질환으로 연하곤란과 흉통이 가장 흔한 증상이면 다량의 토형은 드문 것으로 되어 있다. 본원에서는 다량의 토형을 동반한 식도 결핵에 의한 식도 대동맥루를 가진 환자를 지험했다. 4세 남자 환자는 다량의 토혈로 응습실을 통해 입원했다. 내원 당시 응급으로 시행한 내시경 검사상 incisor로부터 25cm 하방에 0.7 cm의 풍부한 혈관성의 육아종성 병변을 발견하고, 응급개흉술로 식도의 종양성 병변에 대해 쐐기 절제술을 시행하였다. 식도의 종양성 병변부위는 대동맥과 심게 유착되어 있었고 식도에서 대동맥쪽으로의 식도루를 이중 결찰했다. 환자는 술후 8일째 갑작스런 흉관을 통한 다량의 출혈과 구토 후 토형이 있어 응급 재 개흉술을 시행하여 대동맥파열과 식도 문합부 파열을 확인하였으나 더 이상의 교정이 불가능하여 사망하였다. 이에 문헌고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• v.21 no.1
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• pp.191-195
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• 1988

Chylothorax in the neonatal period is a rare cause of respiratory distress. Surgical ligation of the thoracic duct is rarely necessary in congenital chylothorax. A 3 day-old newborn delivered by the cesarean section showed signs of respiratory distress suddenly and diagnosed as chylothorax on the right hemithorax. Conservative management such as multiple thoracenteses and tube thoracostomy drainage with nutritional support failed to close the leakage. At age of 60 days, we performed a supradiaphragmatic mass ligature of the thoracic duct visualized after injection of methylene blue into the thigh subcutaneously. Postoperatively, chylous effusion occurred in the left hemithorax and successfully treated with chest tube drainage for several days.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.753-757
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• 2010

We report hereon a case of double bypass of the esophagus and descending thoracic aorta for the treatment of esophagopleural fistula and aortopleural fistula due to an infected aortic aneurysm after esophageal rupture. A 48 year old man was diagnosed as having esophageal rupture after an accidental explosion. Although he had been treated by esophageal repair and drainage at another hospital, the esophageal leakage could not be controlled and subsequent empyema developed in the left pleura. Further, bleeding from the descending thoracic aorta had developed and he was managed with endovascular stent insertion to the descending thoracic aorta. He was transferred to our hospital for corrective surgery. We performed esophago - gastrostomy via the substernal route, without exploring posterior mediastinum and we let the empyema resolve spontaneously. While he was being managed postoperatively Without any signs and symptoms of infection, sudden bleeding developed from the left pleural cavity. After evaluation for the bleeding focus, we discovered an Infected aortic aneurysm and an aortospleural fistula at the stent insertion site. We performed a second bypass procedure for the infected descending thoracic aorta from the ascending aorta to the descending abdominal aorta via the right pleural cavity. We found leakage at the distalligation site during the immediate postoperative period, and we occluded the leakage using a vascular plug. He discharged without complications and he is currently doing well without any more bleeding or other complications.

• Journal of Chest Surgery
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• v.40 no.7 s.276
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• pp.499-502
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• 2007

Left ventricular inflow obstruction can be caused by a persistent left superior vena cava (SVC) and a dilated coronary sinus. A 31-day-old male infant with secondum atrial septal defect (ASD) and bilateral SVC underwent an operation for treating his uncontrollable congestive heart failure. The preoperative 2-dimensional echocardiography showed a normally sized mitral valve shrouded by a dilated coronary sinus. The operation consisted of pericardial patch closure of the ASD, coronary sinus unroofing and left SVC transfer to the right atrial auricle. The postoperative course was complicated by persistent chylothorax, which was controlled by thoracic duct ligation, He was discharged to home at the postoperative day 39. He has been followed up for 9 months and has displayed normal development.