食管癌切除术后胸腔积液18例临床分析

Clinical analysis of 18 cases of pleural effusion after operation for esophageal carcinoma

目的探讨食管癌术后合并胸腔积液的原因及防治。方法对我科1990年1月—2009年8月食管癌切除术后胸腔积液18例患者的临床资料进行回顾性分析。结果本组术后胸腔积液发生率2.5%;单纯性胸腔积液13例(72.2%),乳靡胸4例(22.2%),胃壁坏死1例(5.6%);再手术治疗3例(16.7%),再次做闭式引流6例(33.3%),重新放置胸腔闭式引流时间3d～17d;其余患者胸腔穿刺1～3次。全部患者均治愈,平均住院时间22d.结论食管癌术后胸腔积液的发生与患者肿瘤外侵转移、术中损伤胸导管、营养不良、贫血、低蛋白血症及术后出现类肺炎性胸腔积液等因素有关;术中采取多种措施减少术后渗液;术后适时掌握拔管时机,根据积液量及性质采取积极有效的治疗措施以提高手术成功率。

Objective To investigate the causes, prevention and treatment of pleural effusion after operation for esophageal carcinoma.Methods From January 1990 to August 2009, 18 cases of pleural effusion patients after operation for esophageal carcinoma were analyzed retrospectively.Results In this group,the incidence of pleural effusion is 2.5% ; 13 cases of isolated pleural effusion （72.2%） ,4 cases of milk extravagant chest （22.2%）, 1 case of gastric necrosis （5.6%） ; 3 cases of reoperation （ 16.7% ）, 6 cases of one more thoracic closed drainage （33.3%） with the time for 3 to 17 days;thoracic puncture from 1 to three times. All the patients are cured with an average hospital stay of 22 days.Conclusion The occurance of pleural effusion after operation is related to many factors such as tumor metastasis,injury of thoracic duct during the operation,anaemia and hypoproteinemia and pneumonia alike pleural effusion after the operation;A variety of measures are taken to reduce postoperative exudate during the operation;The proper opportunitys of tracheal extubation are taken.Effective measures have been taken to improve the successful rate of operations according to the amount and property of the pleural effusion.