Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 230-234
Применение повидон-йода для лечения хилоторакса у новорождённых
https://doi.org/10.18821/1560-9510-2021-25-4-230-234Аннотация
Введение. Цель настоящего исследования состоит в демонстрации опыта нехирургического лечения врождённого и приобретённого хилоторакса с использованием повидон-йода у детей.
Материал и методы. В исследовании представлены результаты лечения 10 пациентов с хилотораксом, которым выполнен химический плевродез с использованием препарата повидон-йод. Исследование охватывало период с 2016 по 2020 г. Врождённый характер заболевания был зарегистрирован у 2 пациентов, приобретённая природа заболевания отмечалась у 8 пациентов. Основным показанием к операции являлось отсутствие эффекта на консервативную терапию, включающую отмену кормления и назначение препарата октреотид. Процедура состояла в интраплевральном введении в плевральную полость 4% раствора повидон-йода с расчётной дозой 1 мл/кг и экспозицией раствора на протяжении 4 ч.
Результаты. Процедура интраплеврального введения повидон-йода была эффективная у всех пациентов. Осложнения химического плевродеза были отмечены у 2 пациентов и связаны с отёком лёгкого на стороне введения. Отток лимфы прекратился в среднем на 4-е сутки. Отмечен один неблагоприятный исход, который был обусловлен пороком развития лёгких, несовместимым с жизнью.
Заключение. Интраплевральное введение повидон-йода является эффективным методом лечения хилоторакса у детей.
Список литературы
1. Scottoni F., Fusaro F., Conforti A., Morini F., Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review. J Pediatr Surg. 2015 Oct; 50(10): 1722-5.
2. Christofe N.M., Pessotti C.F.X., Paiva L., Jatene I.B. Incidence and Treatment of Chylothorax in Children Undergoing Corrective Surgery for Congenital Heart Diseases. Braz J Cardiovasc Surg. 2017 Sep-Oct; 32(5): 390-3.
3. Dorsi M., Giuseppi A., Lesage F., Stirnemann J., De Saint Blanquat L., Nicloux M., Assaf Z., Khen Dunlop N., Kermorvant-Duchemin E., Magny J.F., Ville Y., Lapillonne A. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol. 2018 Jan; 38(1): 31-4.
4. Concheiro-Guisan A., Alonso-Clemente S., Suarez-Albo M., DuranFernandez Feijoo C., Fiel-Ozores A., Fernandez-Lorenzo J.R. The Practicality of Feeding Defatted Human Milk in the Treatment of Congenital Chylothorax. 2019 Nov; 14(9): 648-53.
5. White M.K., Bhat R., Greenough A. Neonatal Chylothoraces: A 10-Year Experience in a Tertiary Neonatal Referral Centre. Case Rep Pediatr. 2019; 2019: 3903598.
6. Long W.G., Cai B., Deng J.M., Liu Y., Wang W.J., Luo J. Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature. Transl Pediatr. 2020 Aug; 9(4): 551-60.
7. Le Nué R., Molinaro F., Gomes-Ferreira C., Scheib-Brolly C., Escande B., Kühn P., Lacreuse I., Favre R., Becmeur F. Surgical management of congenital chylothorax in children. Eur J Pediatr Surg. 2010 Sep; 20(5): 307-11.
8. Moreira-Pinto J., Rocha P., Osório A., Bonet B., Carvalho F., Duarte C., Oliveira L. Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review. Pediatr Surg Int. 2011 Aug; 27(8): 805-9.
9. Soto-Martinez M., Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009 Dec; 10(4): 199-207.
10. Azizkhan R.G., Canfield J., Alford B.A., Rodgers B.M. Pleuroperitoneal shunts in the management of neonatal chylothorax. J Pediatr Surg. 1983 Dec; 18(6): 842-50.
11. Brissaud O., Desfrere L., Mohsen R., Fayon M., Demarquez J.L. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). Arch Dis Child Fetal Neonatal Ed. 2003 Nov; 88(6): F531-3.
12. De Beer H., Mol M., Janssen J. Chylothorax. Neth. J. Med. 2000; 56: 25–31.
13. Kim J.E., Lee C., Park K.I., Park M.S., Namgung R., Park I.K. Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion. Korean J. Pediatr. 2012; 55: 177–80.
14. Cho H., Na K., Kim D., Choi Y., Ma J., Jeong I. Chemical pleurodesis using a Viscum album extract in infants with congenital chylothorax. Eur. J. Pediatr. 2014; 173: 823–6.
15. Mitanchez D., Walter-Nicolet E., Salomon R., Bavoux F., Hubert P. Congenital chylothorax: what is the best strategy? Arch. Dis. Child. Fetal Neonatal Ed. 2006; 91: F153–4.
16. Roehr C.C., Jung A., Proquitté H., Blankenstein O., Hammer H., Lakhoo K., Wauer R.R. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006 May; 32(5): 650-7.
17. Büttiker V., Fanconi S., Burger R.Chylothorax in children: guidelines for diagnosis and management. Chest. 1999 Sep; 116(3): 682-7.
18. Rimensberger P.C., Müller-Schenker B., Kalangos A., Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg. 1998; 66: 253-4.
19. Das A., Shah P.S. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev. 2010; 08: CD006388.
20. Bellini C., Cabano R., De Angelis L.C., et al. Octreotide for congenital and acquired chylothorax in newborns: A systematic review. J Paediatr Child Health. 2018; 54: 840-7.
21. Azam M.N., Majhi S.K., Mishra B.N., et al. Bilateral spontaneous chylothorax in a newborn and response to octreotide therapy. Int J Contemp Pediatr. 2017; 4: 658-60.
22. Church J.T., Antunez A.G., Dean A., et al. Evidence-based management of chylothorax in infants. J Pediatr Surg. 2017; 52: 907-12.
23. ÇakırU, KahvecioğluD, YıldızD, etal. Report of a case of neonatal chylothorax that responded to long-term octreotide treatment, and review of the literature. Turk J Pediatr.2015;57:195-7.
24. Saito M., Kamoda T., Kajikawa D., et al. High Dose Octreotide for the Treatment of Chylothorax in Three Neonates. J Neonatal Biol. 2016; 5: 218.
25. Dehghan K. Idiopathic Chylothorax in a Term Neonate and Successful Treatment with Octreotide and Medium Chain Triglyceride – Enriched Formula: A Case Report. Int J Pediatr. 2019; 7: 9535-40.
26. Cleveland K., Zook D., Harvey K., Woods R.K. Massive chylothorax in small babies. J Pediatr Surg. 2009 Mar; 44(3): 546-50.
27. Beghetti M., La Scala G., Belli D., Bugmann P., Kalangos A., Le Coultre C. Etiology and management of pediatric chylothorax. J Pediatr. 2000 May; 136(5): 653-8.
28. Wolff A.B., Silen M.L., Kokoska E.R., Rodgers B.M. Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children. Ann Thorac Surg. 1999 Sep; 68(3): 1053-7.
29. Mattei P., Ed. Fundamentals of Pediatric Surgery. New York: Springer; 2011, 311.
30. Разумовский А.Ю., Степанов Э.А. Хилоторакс в детском возрасте. М.: ГЭОТАР-Медиа; 2011. Текст: электронный. URL: https://www.studmedlib.ru/book/970406793V0014.html
31. Nath D.S., Savla J., Khemani R.G., Nussbaum D.P., Greene C.L., Wells W.J. Thoracic duct ligation for persistent chylothorax after pediatric cardiothoracic surgery. Ann Thorac Surg. 2009; 88(1): 246-51.
32. Pego-Fernandes P.M., Nascimbem M.B., Ranzani O.T., Shimoda M.S., Monteiro R., Jatene F.B. Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children. J Bras Pneumol. 2011 Feb; 37(1): 28-35.
33. Echavarría A., Pinzón V., Barés J.P., Fernández E. Intracavitary treatment of malignant pleural effusion with iodine-povidone. Rev Med Panama. 1991 Jan; 16(1): 69-74.
34. Guo Y., Tang K., Bilaceroglu S., Kalomenidis I., Salleng K.J., Lane K.B., Light R.W. Iodopovidon is as effective as doxycycline in producing pleurodesis in rabbits. Respirology. 2010 Jan; 15(1): 119-1.
35. Cohan R.H., Saeed M., Schwab S.J., Perlmutt L.M., Dunnick N.R. Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study. UrolRadiol. 1988; 10(4): 203-6.
36. Olivares-Torres C.A., Laniado-Laborín R., Chávez-García C., León-Gastelum C., Reyes-Escamilla A., Light R.W. Iodopovidone pleurodesis for recurrent pleural effusions. Chest. 2002; 122(2): 581-3.
37. Agarwal R., Khan A., Aggarwal A.N., Gupta D. Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis. Indian J Med Res. 2012 Mar; 135: 297-304.
38. Murki S., Faheemuddin M., Gaddam P. Congenital chylothorax–successful management with chemical pleurodesis. Indian J Pediatr. 2010 Mar; 77(3): 332-4.
39. Resch B., Freidl T., Reiterer F. Povidone-iodine pleurodesis for congenital chylothorax of the newborn. Arch Dis Child Fetal Neonatal Ed. 2016; 101: F87-8.
40. Borcyk K., Kamil A., Hagerty K., Deer M., Tomich P., Anderson Berry A.L. Successful management of extremely high-output refractory congenital chylothorax with chemical pleurodesis using 4% povidone-iodine and propranolol: a case report. Clin Case Rep. 2018 Feb 27; 6(4): 702-8.
Russian Journal of Pediatric Surgery. 2021; 25: 230-234
Povidon-iodine applied for the treatment of chylothorax in children
https://doi.org/10.18821/1560-9510-2021-25-4-230-234Abstract
Introduction. The aim of this study is to demonstrate the experience of non-surgical treatment of congenital and acquired chylothorax in children using povidone-iodine.
Material and methods. The study presents results of treatment of 10 patients with chylothorax who had chemical pleurodesis with povidone-iodine. The study covered a time period from 2016 to 2020. The congenital character of the disease was registered in 2 patients, the acquired one - in 8 patients. The main indication for surgery was ineffective conservative therapy, including the withdrawal of feeding and the administration of preparation Octreotide. The procedure consisted of intrapleural injection of 4% povidone-iodine solution into the pleural cavity with the calculated dose of 1 ml/kg and solution exposure for 4 hours. Results. The interpleural administration of povidone-iodine was effective in all patients. Complications of chemical pleurodesis were observed in 2 patients and were associated with pulmonary edema on the injection side. Lymph outflow was stopped on average in 4 days. There was one adverse episode which developed because of the lung malformation incompatible with life. Conclusions. Intrapleural administration of povidone-iodine is an effective treatment of chylothorax in children.
References
1. Scottoni F., Fusaro F., Conforti A., Morini F., Bagolan P. Pleurodesis with povidone-iodine for refractory chylothorax in newborns: Personal experience and literature review. J Pediatr Surg. 2015 Oct; 50(10): 1722-5.
2. Christofe N.M., Pessotti C.F.X., Paiva L., Jatene I.B. Incidence and Treatment of Chylothorax in Children Undergoing Corrective Surgery for Congenital Heart Diseases. Braz J Cardiovasc Surg. 2017 Sep-Oct; 32(5): 390-3.
3. Dorsi M., Giuseppi A., Lesage F., Stirnemann J., De Saint Blanquat L., Nicloux M., Assaf Z., Khen Dunlop N., Kermorvant-Duchemin E., Magny J.F., Ville Y., Lapillonne A. Prenatal factors associated with neonatal survival of infants with congenital chylothorax. J Perinatol. 2018 Jan; 38(1): 31-4.
4. Concheiro-Guisan A., Alonso-Clemente S., Suarez-Albo M., DuranFernandez Feijoo C., Fiel-Ozores A., Fernandez-Lorenzo J.R. The Practicality of Feeding Defatted Human Milk in the Treatment of Congenital Chylothorax. 2019 Nov; 14(9): 648-53.
5. White M.K., Bhat R., Greenough A. Neonatal Chylothoraces: A 10-Year Experience in a Tertiary Neonatal Referral Centre. Case Rep Pediatr. 2019; 2019: 3903598.
6. Long W.G., Cai B., Deng J.M., Liu Y., Wang W.J., Luo J. Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature. Transl Pediatr. 2020 Aug; 9(4): 551-60.
7. Le Nué R., Molinaro F., Gomes-Ferreira C., Scheib-Brolly C., Escande B., Kühn P., Lacreuse I., Favre R., Becmeur F. Surgical management of congenital chylothorax in children. Eur J Pediatr Surg. 2010 Sep; 20(5): 307-11.
8. Moreira-Pinto J., Rocha P., Osório A., Bonet B., Carvalho F., Duarte C., Oliveira L. Octreotide in the treatment of neonatal postoperative chylothorax: report of three cases and literature review. Pediatr Surg Int. 2011 Aug; 27(8): 805-9.
9. Soto-Martinez M., Massie J. Chylothorax: diagnosis and management in children. Paediatr Respir Rev. 2009 Dec; 10(4): 199-207.
10. Azizkhan R.G., Canfield J., Alford B.A., Rodgers B.M. Pleuroperitoneal shunts in the management of neonatal chylothorax. J Pediatr Surg. 1983 Dec; 18(6): 842-50.
11. Brissaud O., Desfrere L., Mohsen R., Fayon M., Demarquez J.L. Congenital idiopathic chylothorax in neonates: chemical pleurodesis with povidone-iodine (Betadine). Arch Dis Child Fetal Neonatal Ed. 2003 Nov; 88(6): F531-3.
12. De Beer H., Mol M., Janssen J. Chylothorax. Neth. J. Med. 2000; 56: 25–31.
13. Kim J.E., Lee C., Park K.I., Park M.S., Namgung R., Park I.K. Successful pleurodesis with OK-432 in preterm infants with persistent pleural effusion. Korean J. Pediatr. 2012; 55: 177–80.
14. Cho H., Na K., Kim D., Choi Y., Ma J., Jeong I. Chemical pleurodesis using a Viscum album extract in infants with congenital chylothorax. Eur. J. Pediatr. 2014; 173: 823–6.
15. Mitanchez D., Walter-Nicolet E., Salomon R., Bavoux F., Hubert P. Congenital chylothorax: what is the best strategy? Arch. Dis. Child. Fetal Neonatal Ed. 2006; 91: F153–4.
16. Roehr C.C., Jung A., Proquitté H., Blankenstein O., Hammer H., Lakhoo K., Wauer R.R. Somatostatin or octreotide as treatment options for chylothorax in young children: a systematic review. Intensive Care Med. 2006 May; 32(5): 650-7.
17. Büttiker V., Fanconi S., Burger R.Chylothorax in children: guidelines for diagnosis and management. Chest. 1999 Sep; 116(3): 682-7.
18. Rimensberger P.C., Müller-Schenker B., Kalangos A., Beghetti M. Treatment of a persistent postoperative chylothorax with somatostatin. Ann Thorac Surg. 1998; 66: 253-4.
19. Das A., Shah P.S. Octreotide for the treatment of chylothorax in neonates. Cochrane Database Syst Rev. 2010; 08: CD006388.
20. Bellini C., Cabano R., De Angelis L.C., et al. Octreotide for congenital and acquired chylothorax in newborns: A systematic review. J Paediatr Child Health. 2018; 54: 840-7.
21. Azam M.N., Majhi S.K., Mishra B.N., et al. Bilateral spontaneous chylothorax in a newborn and response to octreotide therapy. Int J Contemp Pediatr. 2017; 4: 658-60.
22. Church J.T., Antunez A.G., Dean A., et al. Evidence-based management of chylothorax in infants. J Pediatr Surg. 2017; 52: 907-12.
23. ÇakırU, KahvecioğluD, YıldızD, etal. Report of a case of neonatal chylothorax that responded to long-term octreotide treatment, and review of the literature. Turk J Pediatr.2015;57:195-7.
24. Saito M., Kamoda T., Kajikawa D., et al. High Dose Octreotide for the Treatment of Chylothorax in Three Neonates. J Neonatal Biol. 2016; 5: 218.
25. Dehghan K. Idiopathic Chylothorax in a Term Neonate and Successful Treatment with Octreotide and Medium Chain Triglyceride – Enriched Formula: A Case Report. Int J Pediatr. 2019; 7: 9535-40.
26. Cleveland K., Zook D., Harvey K., Woods R.K. Massive chylothorax in small babies. J Pediatr Surg. 2009 Mar; 44(3): 546-50.
27. Beghetti M., La Scala G., Belli D., Bugmann P., Kalangos A., Le Coultre C. Etiology and management of pediatric chylothorax. J Pediatr. 2000 May; 136(5): 653-8.
28. Wolff A.B., Silen M.L., Kokoska E.R., Rodgers B.M. Treatment of refractory chylothorax with externalized pleuroperitoneal shunts in children. Ann Thorac Surg. 1999 Sep; 68(3): 1053-7.
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32. Pego-Fernandes P.M., Nascimbem M.B., Ranzani O.T., Shimoda M.S., Monteiro R., Jatene F.B. Video-assisted thoracoscopy as an option in the surgical treatment of chylothorax after cardiac surgery in children. J Bras Pneumol. 2011 Feb; 37(1): 28-35.
33. Echavarría A., Pinzón V., Barés J.P., Fernández E. Intracavitary treatment of malignant pleural effusion with iodine-povidone. Rev Med Panama. 1991 Jan; 16(1): 69-74.
34. Guo Y., Tang K., Bilaceroglu S., Kalomenidis I., Salleng K.J., Lane K.B., Light R.W. Iodopovidon is as effective as doxycycline in producing pleurodesis in rabbits. Respirology. 2010 Jan; 15(1): 119-1.
35. Cohan R.H., Saeed M., Schwab S.J., Perlmutt L.M., Dunnick N.R. Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study. UrolRadiol. 1988; 10(4): 203-6.
36. Olivares-Torres C.A., Laniado-Laborín R., Chávez-García C., León-Gastelum C., Reyes-Escamilla A., Light R.W. Iodopovidone pleurodesis for recurrent pleural effusions. Chest. 2002; 122(2): 581-3.
37. Agarwal R., Khan A., Aggarwal A.N., Gupta D. Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis. Indian J Med Res. 2012 Mar; 135: 297-304.
38. Murki S., Faheemuddin M., Gaddam P. Congenital chylothorax–successful management with chemical pleurodesis. Indian J Pediatr. 2010 Mar; 77(3): 332-4.
39. Resch B., Freidl T., Reiterer F. Povidone-iodine pleurodesis for congenital chylothorax of the newborn. Arch Dis Child Fetal Neonatal Ed. 2016; 101: F87-8.
40. Borcyk K., Kamil A., Hagerty K., Deer M., Tomich P., Anderson Berry A.L. Successful management of extremely high-output refractory congenital chylothorax with chemical pleurodesis using 4% povidone-iodine and propranolol: a case report. Clin Case Rep. 2018 Feb 27; 6(4): 702-8.
