胸腔镜术与开胸术治疗术后乳糜胸回顾性对比分析

Retrospective contrast analysis of Video-assisted thoracoscopic surgery and Thoracotomy in treating postoperative chylothorax

目的探讨电视胸腔镜术治疗术后乳糜胸的临床价值。方法回顾性对比分析11例术后乳糜胸病人施行胸导管结扎术的临床资料,其中6例行开胸手术(开胸组),5例行VAT(SVATS组)。结果所有病例均顺利完成胸导管结扎术,VATS组的手术时间明显较开胸组延长(P<0.05),术中出血量明显少于开胸组(P<0.05),手术切口的愈合时间(P<0.05)、术后住院时间(P<0.05)均较开胸组明显缩短,术后疼痛评分(P<0.05)、术后强止痛药(吗啡)用量(P<0.05)明显少于开胸组,胸管引流时间(P>0.05)、胸管引流量(P>0.05)、血常规恢复至正常时间(P>0.05)两组差异无显著性,两组均无术中、术后并发症,随访6￣12个月,随访率100%,均无复发。结论电视胸腔镜手术治疗术后乳糜胸疗效确切,具有创伤小、出血少、疼痛轻、术后切口愈合快和住院时间短等优点,为治疗术后乳糜胸的首选方法。

[Objective] To evaluate the clinical impacts of video-assisted thoracoscopic surgery in treating postoperative chylothorax. [Methods] Retrospective constract analysis of the clinical data of 11 patients who developed postoperative chylothorax. All of them underwent ligation of thoracic duct, 6 patients thoracotomy （thoracotomy group）, 5 patients VATS （VATS group）. [Results] All of the patients underwent ligation of thoracic duct smoothly. The operative time was significantly longer for VATS group than for the thoracotomy group （ P 〈0.05）; the blood loss during operation was significantly less for VATS group than for the thoracotomy group （P〈0.05）; the time for incisional heal and the duration of hospitalization after operation were significantly shorter for VATS group than for the thoracotomy group （ P 〈0.05）; postoperative ache grade and the dose of intensive anodyne（morphine） used were significantly less for VATS group than for the thoracotomy group （ P 〈0.05）. There were no significant difference for the two groups at the duration and the volume of postoperative drainage and at the time of blood RT regain normal （ P 〉 0.05）. There were no complications for the two groups during or after operation. There were no recurrence of chylothorax during Follow-up （range, 6 to12 months）, and the rate of follow-up was 100%. [Conclusions] VATS is an effective tool in the management of postoperative chylothorax. Its minimal invasion, less blood loss, less pain, rapid incisional healing and short length of stay suggest it is a preferred treatment of postoperative thvlothorax.