食管癌术后并发乳糜胸的诊断和治疗

Diagnosis and treatment of postoperative chylothorax in esophageal cancer patients

目的探讨食管癌手术后并发乳糜胸的诊断与治疗方法。方法回顾性研究该科2008年9月～2011年1月收治的1192例食管癌手术患者的临床病例资料,手术后并发乳糜胸共13例。术后胸管引流量小于800 ml者先予以保守治疗,效果不明显再予以外科手术治疗。胸管引流量大于1 000 ml者直接外科手术治疗。结果经保守治疗治愈7例,经手术治疗治愈6例。结论食管癌术后如果胸管引流量持续增多,超过600 ml.d-1,应高度警惕乳糜胸可能,结合生化检查,可明确乳糜胸诊断。一旦发生术后乳糜胸,应及时采取恰当的治疗方法。若保守治疗效果不佳或漏出乳糜量大,应积极外科手术,行胸导管结扎术。

Objective To explore the diagnosis and treatment of postoperative chylothorax in esophageal cancer patients.Methods 1 192 patients with esophageal cancer underwent resection of the cancer from September 2008 to January 2011.13 of them had postoperative chylothorax.Patients with postoperative thoracic drainage volume（PTDV） less than 800 ml·d-1 underwent conservative therapy first,and ligation of thoracic duct was performed directly on the patients with PTDV more than 1 000 ml·d-1.Results Among the 13 patients of postoperative chylothorax,7 cases were cured by conservative therapy and 6 cases were cured by surgical treatment.Conclusion When the PTDV after operation is more than 600 ml·d-1,the diagnosis of postoperative chylothorax should be suspected.Conservative therapy is valid for postoperative chylothorax with the PTDV less than 800 ml·d-1.Operation of thoracic duct ligature should be considered if conservative therapy failed or the amount of postoperative thoracic drainage volume is great.