胸导管结扎在肺癌手术中应用的临床研究

Clinical study of thoracic duct ligation applied in pulmonary carcinoma resection

目的探讨肺癌手术中行常规胸导管结扎的可行性及优越性。方法将80例肺癌手术患者随机分成研究组(胸导管结扎组)和对照组(不结扎胸导管),两组均进行系统的淋巴结清扫。观察两组的术中术后情况及围手术期并发症发生情况,术前、术后1周分别进行血清载脂蛋白电泳,术前、术后2周、4周分别进行T细胞亚群测定,并进行统计学分析。结果两组比较,手术时间、失血量无显著性差异(P>0.05);术后乳糜胸的发生率无显著性差异(P>0.05);Ⅱ期、Ⅲa期患者胸腔引流量减少、带管时间及术后住院天数缩短(P<0.05);Ⅰ期患者两组术后胸腔引流量、带管时间、术后住院天数无显著性差异;两组手术前后血清载脂蛋白电泳以及手术前后T细胞亚群无显著性差异(P>0.05)。结论肺癌手术中行胸导管结扎,不增加手术创伤,对术后肠道营养吸收及免疫功能的恢复没有影响,对于Ⅱ期Ⅲa期肺癌患者,行术中行胸导管结扎可以有效减少术后胸腔引流量,缩短术后住院时间。

Objective To evaluate the safety and efficacy of thoracic duct ligation applied in pulmonary carcinoma resection. Methods 80 cases of pulmonary carcinoma were randomly divided into experimental group receiving thoracic duct ligation in operation, control group without thoracic duct ligation, all cases receiving systematic lymph node dissection. Intraoperative and postoperative data, complication, preoperative and the 7th clay postoperative blood serum apolipoprotein electrophoresis, preoperative and the 7th, 14th clay postoperative T subsets were collected, compared and statistically analyzed. Results Compared with control group, no significant difference were found in operative time, blood loss, the rate of postoperative chylothorax. Significant difference were found in thoracic drainage, duration of thoracic catheter drainage, postoperative hospital stay for patients of stage Ⅱ and Ⅲ, but no significant difference for patients of stage Ⅰ . No significant difference were found in serum apolipoprotein electrophoresis and T subsets. Conclusion Thoracic duct ligation applied in pulmonary carcinoma resection won＇ t affect the trauma of operation, the absorption of nutrients from intestinal tract and the recovery of immune function, but will reduce thoracic drainage efficiently, shorten postoperative hospital stay for pulmonary carcinoma patients of stage Ⅱand Ⅲ.