预防性胸导管结扎对食管癌根治术后并发症及出院时间的影响

Effects of Preventive Thoracic Duct Ligation on Post-Operative Complications and Discharge Time in Patients with Esophageal Cancer after Radical Operation

目的:通过比较食管癌病人根治术中是否预防性结扎胸导管的术后并发症及出院时间,探讨预防性胸导管结扎的临床价值。方法:收集我院2014年6月至2016年6月食管癌根治术的病例资料进行回顾性分析,按照是否进行预防性胸导管结扎分为两组,结扎组28例,未结扎组31例。收集两组病人的基本资料、术后并发症、术后住院时间等,两组间差异比较采用卡方检验,t检验,秩和检验。结果:虽然患者术后均有不同程度的低蛋白血症,但均未发生乳糜胸,结扎组术后平均胸腔积液量(2 371.14±1 589.87) mL,呼吸道感染14例(50.00%),吻合口瘘4例(14.29%),吻合口出血2例(7.14%),肺动脉栓塞1例(3.57%),死亡1例(3.57%),出院时间(20.96±8.64) d;未结扎组术后平均胸腔积液量(3 090.10±3 359.38)mL,呼吸道感染10例(32.26%),吻合口瘘5例(16.13%),功能性胃排空障碍1例(3.23%),出院时间(21.23±13.73) d。术后并发症及出院时间在两组间的差异均不具有统计学意义(P>0.05)。结论:食管癌根治术中进行预防性胸导管结扎对术后并发症的发生和术后住院时间没有显著影响,因此除术中明确有胸导管损伤外,不建议食管癌术中行预防性胸导管结扎。

Objective: This article investigates the clinical value of the ligation of the thoracic duct by analyzing the occurrence of complications and the length of discharge time in patients with esophageal cancer in recent 3 years in our hospital. Methods: The data of patients with esophageal cancer between June 2014 and June 2016 in our hospital were retrospectively analyzed. A ll the patients were divided into two groups based on the preventive ligation of the thoracic duct, i.e., ligation group(28 cases) and non-ligation group(31 cases). The baseline data, postoperative complications and discharge time in two groups were compared by χ2, t test, or rank sum test. Results: Though all patients suffered from hypoproteinemia, no chylothorax cases were found in both groups. The ligation group had average postoperative pleural effusion(2 371.14 ± 1 589.87) mL, 14 cases(50.00%) of respiratory tract infection, 4 cases(14.29%) of anastomotic fistula, 2 cases(7.14%) of anastomotic bleeding, 1 case(3.57%) of pulmonary embolism, 1 death case(3.57%), and discharge time was(20.96 ± 8.64)d. W hile the non-ligation group had postoperative average amount of pleural effusion(3 090.10 ± 3 359.38) mL,10 cases(32.26%) of respiratory tract infection, 5 cases(16.13%) of anastomotic fistula, 1 case(3.22%) of functional delayed gastric emptying, and discharge time was(21.23 ± 13.73) d. The differences of all the postoperative complications and the discharge time between two groups showed no statistical significance(all P > 0.05). Conclusion: Prophylactic ligation of thoracic duct in esophageal cancer patients with radical operation may not influence significantly the post-operative complications and the discharge time. Such ligation is not advisable within the operation except there is an obvious thoracic duct injury.