食管、贲门癌术后乳糜胸的诊断和外科治疗

Diagnosis and surgical treatment of chylothorax after operation for esophageal and cardiac cancers

目的探讨食管、贲门癌手术后乳糜胸的诊断与外科治疗。方法回顾性研究1990年1月到2006年12月1924例食管癌和贲门癌外科手术患者的临床资料,术后并发乳糜胸35例。术后胸液量小于500ml者先行保守治疗,效果不佳再行手术治疗。胸液量大于1000ml者直接手术治疗。结果保守治疗治愈11例,手术治疗治愈23例,拒绝二次手术1例。结论食管、贲门癌切除术后如果胸液量持续增多或减少后又增多,胸液量达到或超过500ml/24h,应高度怀疑乳糜胸可能,结合实验室检查,可明确乳糜胸的诊断。保守治疗具有疗效可靠、不良反应少等优点。若保守治疗效果不佳,或漏出乳糜量大则应进行积极的外科手术,行胸导管结扎术。

Objective To investigate the diagnosis and surgical treatment of postoperative chylothorax after the operation for esophageal and cardiac cancers. Methods 1924 patients with esophageal and cardiac cancers underwent resection of the cancer from January 1990 to December 2002. Postoperative chylothorax was found in 35 of them, 22 males and 13 females, aged 53.5 （44 - 72）, with chyle drained from the thoracic cavity 250-1800 ml in amount per day . Twelve patients with the thoracic drainage fluid less than 500 ml in amount per day underwent conservative therapy first： suspension of hypertonic glucose and erythromycin was injected into the thoracic cavity with the drainage tube closed, the patients were asked to change their postures often, and the thoracic fluid was drained 12 h later. If obvious curative effect failed to be achieved 3 days later, treatment was switched over to operation. And ligation of thoracic dust was performed directly on the patients with drained thoracic fluid more than 1 000 ml per day. Results Among the 35 cases of postoperative chylothorax, 11 were cured by conservative therapy, and 23 with drained thoracic fluid more than 1 000 ml per day were transferred to the group of surgical treatment , and one refused to be treated surgically. Conclusion When an amount of thoracic drainage fluid after operation is more than 500 ml per day, the diagnosis of postoperative chylothorax should be suspected. Conservative therapy is effective for postoperative chylothorax with the thoracic drainage fluid less than 500 ml per day. Operation of ligation of thoracic dust should be performed if conservative therapy fails or the amount of drainage fluid is great.