Ⅲ期肺癌手术后乳糜胸的术中预防措施和效果

Effect of preventive management during operation for post-operative chylothorax in patients with lung cancer of state Ⅲ

目的总结Ⅲ期肺癌术后并发乳糜胸的防治经验，评价术中针对乳糜胸预防处理的临床效果。方法1998年1月～2005年6月共行Ⅲ期肺癌切除术425例，所有病例术中均行隆凸下和纵隔淋巴结彻底清扫术。其中从2004年3月起。132例患者在术中针对乳糜胸常规采取了预防措施，并以此分为无预防组和预防组。结果无预防组中14例患者术后发生乳糜胸，发生率为4．8％，10例保守治愈，3例再次手术，1例死亡；预防组中仅1例患者术后发生乳糜胸，发生率为0．07％，保守治愈。两组间比较差异有统计学意义（P〈0．05）。结论Ⅲ期肺癌手术后乳麇胸发生率较高，应引起足够的重视。术中预防性处理可疑的淋巴管损伤是降低术后乳糜胸并发症和提高手术安全性及成功率的重要措施。

Objective To review the effects of preventive management during the operation for postoperative ehylothorax in patients with lung cancer of state Ⅲ. Methods Total 425 patients underwent pulmonary resection （at least lobectomy） and systematic mediastinal lymph node dissection for lung cancer of state Ⅲ from January 1998 to June 2005. Took some especial management during the operation to prevent post- operative ehylothorax in 132 patients after March 2004. According to the surgical procedure,all patients were divided into preventive group and non - preventive group. Results There were 14 patients （4.8%） with post- operative ehylothorax in the group of inchoate 293 patients before March 2004. Only 1 patient （0.07%） among 132 patients who underwent treatment for chylothorax during the operation after March 2004 had post- operative ehylothorax （P〈0.05）. Eleven patients healed via conservative management, 3 patients underwent reoperation, 1 patient was dead because of lung infection. Conclusion More chylothorax happened after operation in patients with lung cancer of state Ⅲ. To take some ruanagement during the operation can raise the safety and success rate of the operation.