食管癌术后乳糜胸的相关因素及其治疗

FACTORS RELATIVE TO POSTOPERATIVE CHYLOTHORAX OF ESOPHAGEAL CANCER AND ITS TREATMENT

目的进一步研究食管癌术后乳糜胸的发生发展规律，研究乳糜胸的有效诊断，治疗及预防措施。方法回顾性分析本科１９７６～１９９６年４２０１例食管癌手术及３４例术后乳糜胸病例。重点分析手术方式、术前放疗与乳糜胸发生的关系，评价术中预防结扎胸导管的意义。结果①左侧开胸食管癌切除弓下吻合、弓上吻合、颈部吻合及右侧开胸颈部吻合术后乳糜胸发生率分别为０４％（１／２３９）、０９％（２５／２９２２）、０９％（７／７８２）和２３％（１／４３）。（各组间比较Ｐ＞００５）。②单纯手术、术前计划放疗、根治性放疗后复发术后乳糜胸发生率分别为０７％（２８／３８１１）、１６％（２／１２８）、８５％（４／４７）。（前二组比较Ｐ＞００５，和放疗后复发组比较Ｐ＜００１）。③术中胸导管结扎和未结扎术后乳糜胸发生率分别为０８％（１５／１７９１）和０９％（１９／２１９５）（Ｐ＞００５）。结论①各种手术方式、不同平面吻合后乳糜胸发生率无差别。②根治放疗后复发手术乳糜胸发生率明显高于单纯手术和术前计划放疗，而术前计划放疗和单纯手术无差别。③术中胸导管预防结扎不能有效降低乳糜胸发生率，因此不主张常规预防结扎胸导管。

PURPOSE To explore patterns of occurence and development,effective measures of diagnosis,treatment and prevention of postoperative chylothorax of esophageal cancer. METHODS A retrospective analysis was undertaken from data of 34 cases of postoperative chylothorax out of 4201 patients with esophageal cancer in Anyang Cancer Hospital from 1976 to 1996.The main points analysed were relations of operative methods,preoperative radiotherapy to postoperative chylothorax incidence,and evaluated the value of preventive ligation of thoracic duct. RESULTS ①Postoperative chylothorax incidences of infra aortic,supra aortic,cervical anastomosis by left thoracotomy,and cervical anastomosis by right thoracotomy after resection of esophageal cancer were 0.4%(1/239),0.9%(25/2922),0.9%(7/782),and 2.3%(1/43) respectively( P >0 05).②Chylothorax incidences of operation only, planned preoperative radiotherapy,and recurrence after radical radiotherapy were 0.7%(28/3811),1.6%(2/128),and 8.5%(4/47)respectively( P >0.05, compasrison between the first two groups;and P <0 01,for the last two groups).③ Chylothorax incidence of thoracic duct that had been ligated and had not been ligated were 0.8%(15/1791) and 0.9%(19/2195) respectively( P >0.05). CONCLUSIONS ①There is no difference for postoperative chylothorax incidence for various operative ways and anastomotic levels.②Chylothorax incidence of recurrence after radical radiotherapy is obviously higher than operative only and planned preoperative radiotherapy,but there is no difference between operation only and planned preoperative radiotherapy.③ Preventive ligation of thoracic duct in operation does not decrease chylothorax incidence and therefore routine ligation of thoracic duct is not recommended.