预防性胸导管结扎术在食管癌根治术中应用的评价

Evaluating Prophylactic Ligation of Thoracic Duct during Radical Resection of Esophageal Carcinoma

背景与目的:胸导管结扎术是食管癌切除术中预防和治疗乳糜胸的常用方法,但对于其预防乳糜胸的作用存在争议,且有关胸导管结扎术对食管癌术后其它并发症及预后的影响的研究很少,本研究目的是评价预防性胸导管结扎术对预防乳糜胸的作用及其对并发症和预后的影响。方法:回顾性分析1991年1月至1996年5月在中山大学肿瘤防治中心行食管癌根治术,并有明确记载是否行预防性胸导管结扎术的病例共389例,分为未结扎组218例和结扎组171例,对比两组乳糜胸和其它并发症的发生率及患者生存率,评价预防性胸导管结扎术的临床价值。结果:未结扎组和结扎组乳糜胸发生率分别为0.46%(1/218)和1.17%(2/171)(P<0.001)。未结扎组和结扎组并发症发生率分别为11.5%(25/218)和18.1%(31/171)(P=0.063);围手术期死亡率分别为0.92%(2/218)和1.75%(3/171)(P=0.658)。结扎组和未结扎组1、2、3、5年生存率分别为75.2%、52.2%、42.2%、29.2%和74.2%、53.2%、43.2%、29.8%,P值分别为0.992、0.819、0.841、0.902;两组生存曲线采用log-rank检验,P=0.464。结论:预防性胸导管结扎术不能有效预防乳糜胸,且对食管癌根治术后并发症发生率和患者预后无明显影响。

BACKGROUND ＆ OBJECTIVE. Prophylactic ligation of thoracic duct during the radical resection of esophageal carcinoma is usually used to prevent and treat chylothorax, but there is dispute about the effect, Its correlation to other complications and prognosis of esophageal carcinoma patients after operation has seldom been reported. The study was to evaluate its preventive effect on chylothorax and its influences on other complications and prognosis of esophageal carcinoma patients. METHODS. Clinical data from 389 patients who underwent radical transthoracic esophagectomy from Jun. 1991 to Jun. 1996 in Cancer Center of Sun Yat-sen University were retrospectively analyzed. Of the 389 patients, 171 received thoracic duct ligation （ligation group）, and 218 had thoracic duct preserved （preservation group）. The occurrence rates of chylothorax and other complications, and the survival rates were compared between the 2 groups. RESULTS. The occurrence rates of chylothorax were 1.17% in ligation group and 0.46% in preservation group （P〈0.001）. The occurrence rates of complication were 18.2% in ligation group and 11.5% in preservation group （P=0.063）. Perioperative mortalities were 1.75% in ligation group and 0.92% in preservation group （P=0.658）. The 1-, 2-, 3-, and 5-year survival rates were 74.3%, 52.1%, 42.1%, and 29.2% in ligation group, and 74.3%, 53.2%, 43.1%, and 29.8% in preservation group （P=0.992, 0.819, 0.841, 0.902）. CONCLUSION, Prophylactic ligation of thoracic duct during esophagectomy for paitients with esophageal carcinoma could not prevent chylothorax effectively, and has no obvious influence on the occurrence of other complications and survival of the patients after operation.