食管癌胸导管结扎术后乳糜腹5例并文献复习

Treatment of chylous ascites after esophageal cancer(15 cases)

目的探讨食管癌胸导管结扎术后乳糜腹的发生机制及治疗方法。方法回顾性总结分析该院及南方医科大学附属南方医院胸心血管外科2000年1月至2008年6月食管癌胸导管结扎术后并发的5例乳糜腹病例。所有病例均再次手术治疗。治疗方法包括胸导管膈上低位多平面再次结扎、膈下漏液创面缝扎、应用止血纱布填塞压迫渗液区以及生物胶封闭创面。结果除1例再次手术后引流液持续不减自动出院外,其余4例患者均痊愈出院。结论食管癌胸导管结扎术后乳糜腹与胸导管结扎位置高、胸导管变异以及贲门部清扫创面过度应用电刀有关;对食管癌胸导管结扎术后乳糜腹的患者,应先保守治疗,保守治疗无效后应积极手术治疗。

[Objective] To research the reason and treatment of chylous ascites after esophageal cancer. [Method] Observe the outcome of five cases chylous ascites after esophageal cancer in our hospital and Nanfang hospital from Jan 2000 to Jun 2008.All the cases were operated. The treatments including ligated alimentary duct just on the diaphragm and transfixion the cataclysm of surface of wound under the diaphragm and hemostasis qauze waded and biogel obturated the surface of wound. [Results] Four patients cured after the operation, only one patient left hospital automatism for the reason of the drain hquid did not reduced after the operation. [ Conclusions ] The reason chylous ascites after esophageal cancer includind the place of liquated alimentary duct was high and variance of alimentary duct and used electrotome in the cardia cleating.The treatment of chylous aseites after esophageal cancer should be quard treatment firstly, if the quard treatment inefficacy, it should be operated actively.