肺癌淋巴结清扫不同术式对并发乳糜胸的影响比较

The Comparision of Chylothorax after Pulmonary Resection for Lung Cancer by different methods of Lymph Node Dissection

目的:探讨肺癌淋巴结清扫不同术式(采样组与根治组)对乳糜胸发生率、治疗和转归的影响。方法:回顾分析1997年5月—2003年6月1373例肺癌术后(肺叶切除术+淋巴结采样)并发6例乳糜胸的资料,以及2003年7月—2008年7月1679例肺癌术后(肺叶切除术+系统性淋巴结根治,包括胸腔镜)并发19例乳糜胸的临床资料。结果:采样组术后乳糜胸的发生率为0.44%,根治组为1.13%,两者有显著差异(P=0.034)。采样组所有病例均行保守治疗,根治组17例保守治疗,2例手术治疗成功,无死亡病例。结论:肺癌术后乳糜胸的发生率和淋巴结清扫方式明显相关;治疗转归由于淋巴结清扫方式不同而不同;营养支持治疗使保守治疗的有效率不断提高。

Objective：To explore incidence, treatment and turnover of chylothorax after pulmonary resection for lung cancer by different methods of lymph node dissection（ Sampling group and Radical group）. Methods： 1373 patients underwent pulmonary resection （at least lobectomy ＋ systematic mediastinal lymph node sampling） for lung cancer from May, 1997 to June, 2003 were retrospectively reviewed, and 6 cases had postoperative chylothorax. 1679 patients underwent pulmonary resection （at least lobectomy ＋ systematic mediastinal lymph node radical dissection, including VATS lobectomy） for lung cancer fromJuly,2003 to July, 2008 were retrospectively reviewed, and 19 cases had postoperative chylothorax. Results： The incident rate of postoperative chylothorax in Sampling group is 0.44%,Radical group is 1.13%. There is significant difference between Sampiing group and Radical group（P = 0. 034）. All cases of Sampling group and 17 cases of Radical group cured by conservative treatment. Among 19 cases of Radical, 2 cases cured by operative treatment. There is no mortality. Conclusion：There is significantly relevant between the incidence and cause of ehylothorax after pulmonary resection for lung cancer and methods of lymph node disseetion. The turnover of treatment is different for different methods of lymph node disseetion. The achievement rate of conservative treatment improve by progression on various kinds of support nutrition.