胸导管结扎预防食管癌术后乳糜胸的临床研究

Clinical study of preventing chylothorax by ligation of thoracic duct during resection of esophageal carcinoma

目的 寻找减少或消除食管癌切除术后乳糜胸发生率的有效方法。方法 随机选取 45例 (A组 )食管癌患者 ,在食管癌切除加胃 食管残端吻合时 ,一期行预防性低位胸导管结扎术 (第 8胸椎水平以下 ) ;另 92例 (B组 )作对照组 ,仅做食管癌切除加胃 -食管残端吻合术。结果 两组患者在术后乳糜胸发生率 (A :1/ 45 ;B :9/ 92 ,P =0 0 3)、术后 48h胸腔引流量〔第 1个 2 4h :A :(2 5 4 33± 45 15 )ml,B :(4 93 6 1± 76 6 7)ml;第 2个 2 4h :A :(141 11± 2 5 5 3)ml,B :(32 3 39± 5 8 17)ml;P <0 0 5 )〕、3天内拨管率 (A :94 78% ;B :6 2 2 1% ,P =0 0 0 1)、并发症 (A :3/ 45 ,B :0 / 92 ,P =0 0 34)以及随访锁骨上淋巴结转移 (A :0 / 45 ,B :9/ 92 ,P =0 0 3)等方面有统计学意义。结论 术中行预防性低位胸导管结扎术可明显减少甚至消除食管癌患者术后乳糜胸的发生。

Objective\ To find out a good method to reduce or eliminate the chylothorax after resection of esophageal carcinoma. Methord\ 45 patients of the esophageal carcinoma (Group A)who were, at random, elected had been undergone the ligation of thoracic duct( Low level: under the 8th thoracic vertebrae) during resection of esophageal carcinoma and esophagogastrostomy, while the other 92 patients of the esophageal carcinoma(Group B)had only been operated the resection of esophageal carcinoma and esophagogastrostomy. Results\ There were statistical significances between Group A and B on the incidence rate of the chylothorax after operation(A:1/45;B:9/92, P =0.03) , thoracic drainage within 48 h(the first 24 h:A:254.33 ml±45.15 ml,B:493.61 ml±76.67 ml;the second 24 h:A:141.11 ml±25.53 ml,B:323.39 ml±58.17 ml; P <0.05),the decannulation rate within 3 days (A:94.78%;B:62.21%, P =0.001) ,complication(A:3/45; B:0/92, P =0.034) and cancer metastasis of supraclavicular lymph nodes (A:0/45;B:9/92, P =0.03) by follow-up. Conclusion The preventive ligation of thoracic duct during resection of esophageal carcinoma can indeed reduce or eliminate the incidence rate of the chylothorax after operation.