食管癌术后乳糜胸发生原因与预防策略的临床分析

Causes and Prevention Strategies for Postoperative Chylothorax in Patients with Esophageal Cancer

目的研究并科学分析食管癌术（Esophageal carcinoma）后乳糜胸（Chylous hydrothorax）发生的原因与预防的相关策略,以期能够给食管癌术后乳糜胸患者提供最理想的治疗方案。方法采取回顾性的研究方法,在2012年11月~2014年11月,搜集在我市人民医院接受食管癌术的临床患者资料254例（明确记载有132例患者实施预防性胸导管结扎术,未明确记载有122例患者实施预防性胸导管结扎术）。把明确记载的132例患者分为治疗组,把未明确记载的122例患者分为未治疗组,再具体分析治疗组与未治疗组两组患者的食管癌术后发生乳糜胸的概率、术后的引流量等相关指标。结果 132例治疗组的术后乳糜胸的发生率为0.76%,122例未治疗组的乳糜胸发生概率为9.02%。结论食管癌术后发生乳糜胸的原因一般为在切除食管癌的过程中损伤导管所致,实施预防性胸导管结扎术,可使食管癌术后乳糜胸的发生率明显降低。因此,需要在术中加强预防性胸导管结扎术。

OBJECTIVE Postoperative chylothorax remains a life-threatening complication after esophagectomy for esophageal cancer. In this study,we analyze the causes of chylothorax and identify the prevention strategies. METHODS Clinical data of 254 patients with esophageal cancer undergone esophagectomy from November2012 to November 2014 were retrospectively reviewed. According to the management of thoracic duct,patients were assigned to two groups： prophylactic thoracic duct ligation group（ ligation group,n = 132） and thoracic duct preservation group（ control group,n = 122）. The occurrence rates of chylothorax,and surgical approach were compared between the two groups. RESULTS The occurrence rates of postoperative chylothorax were 0. 25% in ligation group,and 10. 36% in control group（ P〈0. 05）. CONCLUSION Chylothorax post-esophagectomy was mainly caused by injury of the thoracic duct. Prophylactic thoracic duct ligation could effectively prevent postoperative chylothorax.