Yenidoğanda Şilotoraks Tanı ve Tedavisinde Güncel Yaklaşımlar

Yıl 2017, Cilt: 11 Sayı: 1, 76 - 81, 01.04.2017

Mehmet Büyüktiryaki Nilüfer Okur Nurdan Uraş Şerife Suna Oğuz

Öz

Şilotoraks plevral aralıkta lenfatik sıvı birikmesi olarak tanımlanır, konjenital ve akkiz nedenlerle ortaya çıkar. Konjenital şilotoraksın etiyolojisi tam anlaşılamamış olmakla birlikte, lenfatik sistemin gelişimsel bozukluğu sonucu olduğu düşünülmektedir. Konjenital şilotoraks sıklıkla hidrops fetalisle birlikte görülür. Tanı plevral sıvıda trigliserit düzeyinin 110 mg/dl ve total hücre sayısının 1000/ml’nin üstünde olması, %80’den fazla lenfosit içermesi ile konulur. Şilotoraksta klinik durumun şiddetini şilöz mayi miktarı belirler. Bazı bebekler asemptomatik veya hafif solunum sıkıntısı ile klinik bulgu verirken, çoğu olguda tedavi edilmezse potansiyel yaşamı tehdit eden solunum sıkıntısı ile bulgu verir. Şilotoraks tedavisinde konservatif ve cerrahi yöntemler kullanılmaktadır. Konservatif yaklaşım altta yatan hastalığın tedavisi, tekrarlanan torasentez veya toraks tüpü ile sürekli drenaj, enteral beslenmeye ara verilerek total parenteral nutrisyon uygulanması ve orta zincirli trigliseritleri içeren diyet uygulanmasını içerir. Bu yöntemlere yanıt alınamazsa oktreotid kullanılması önerilmektedir. Konservatif tedavi başarısızlığını tanımlamak için kullanılan iki parametre devam eden lenfatik drenajın süresi ve hacmidir. Oktreotid tedavisinin yanıtsız olduğu durumlarda kimyasal plörodezis ve cerrahi tedavi denenmelidir. Cerrahi tedavi yaklaşımları torakoskopik plörodezis, cerrahi abrazyon, pleuroperitoneal şant uygulanması, torasik duktus ligasyonunu içerir. Şilotoraksta prognoz altta yatan etiyolojiye göre değişir. Uygun tedavi ile konjenital şilotoraksın prognozu genellikle iyi seyreder. Bununla beraber eşlik eden pulmoner hipoplazinin derecesi, prematürite ve hidropsun varlığı mortaliteyi artıran nedenler olarak bildirilmektedir.

Anahtar Kelimeler

Oktreotid, Şilotoraks, Yenidoğan

Current Diagnostic and Treatment Approaches in Neonatal Chylothorax

Öz

Chylothorax is defined as the accumulation of lymphatic fluid in the pleural cavity. It results from congenital and acquired causes. Although the etiology of congenital chylothorax is not fully understood, it has been suggested to be a developmental disorder of the lymphatic system. Congenital chylothorax is often accompanied by hydrops fetalis. The diagnosis is made by measurement of the triglyceride level in fluid above 110 mg/dl and total cell count above 1000/ml with 80% lymphocyte. The severity of the clinical condition in chylothorax is determined by the amount of accumulated chylous fluid. Whilst some newborns are asymptomatic or have mild respiratory distress as a clinical symptom, the majority of the cases, if not treated, present with potentially life-threatening respiratory distress. Conservative and surgical methods are used in the treatment of chylothorax. Conservative therapy includes the treatment of the underlying disease, continuous drainage through repeated thoracentesis or thoracic tube, total parenteral nutrition following the suspension of enteral nutrition, and a diet containing medium chain triglycerides. Octreotide use is offered if there is no response to these methods. The two parameters used to define failure of conservative therapy are the duration and the volume of the continuing lymphatic drainage. In cases where octreotide therapy fails, chemical pleurodesis and surgical treatment should be tried. Surgical treatment includes thoracoscopic pleurodesis, surgical abrasion, pleuroperitoneal shunt placement, and thoracic ductus ligation. The prognosis of chylothorax varies depending on the underlying etiology. The prognosis of chylothorax is generally good with appropriate treatment. Nonetheless, the severity of accompanying pulmonary hypoplasia, and presence of prematurity and hydrops have been reported to be among the factors increasing mortality rate

Anahtar Kelimeler

Octreotide, Chylothorax, Newborn

Kaynakça

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