非解剖性胸导管整块结扎切断在复发性乳糜胸手术治疗中的应用

Application of non dissecting thoracic duct ligation cutting in treatment of recurrent chylothorax

目的探讨非解剖性胸导管整块结扎切断在复发性乳糜胸手术治疗中的应用。方法胸导管结扎术后复发性乳糜胸患者22例,总结22例患者手术方式、原手术径路、乳糜胸复发部位和再次术后并发症,分析其乳糜胸复发的可能原因并在常规胸导管整块结扎术的基础上进行针对性改进,采用将除食管、降主动脉以外的后纵隔组织非解剖性整块结扎切断的方式进行再次手术治疗。结果 22例复发性乳糜胸患者再次手术后乳糜胸均缓解,除1例患者术后并发呼吸衰竭外,其余患者术后无严重并发症,术后随访1年无乳糜胸复发。结论采用非解剖性胸导管整块结扎切断手术方式通过消除乳糜胸复发的解剖学基础能够安全有效的治疗复发性乳糜胸。

Objective To investigate the results of non dissecting thoracic duct ligation cutting in treatment of recurrent chylothorax. Methods 22 patients suffered from recurrent chylothorax after original thoracic duct ligation surgery were enrolled and their clinical characteristics were collected,including previous thoracic surgical procedure,previous surgical approach,recurrent chylothorax side and postoperative complications. The probable causes of chylothorax recurrence were analyzed and targeted improvements were made,based on the traditional mass ligation procedure of the thoracic duct. Through the previous approach,non dissecting thoracic duct ligation combined with transection of the posterior mediastinal tissue,except esophagus and thoracic aorta,was applied during the reoperation for the recurrent chylothorax. Results All the patients were recovery form chylothorax after reoperations. There were no severe postoperative complications except one patient suffered from respiratory failure. All the patients discharged evenly without chylothorax recurrence during one-year follow-up period. Conclusion Recurrent chylothorax could be successfully and safely treated by non-anatomical mass ligation combined with transection of the thoracic duct,for the anatomical foundation of chylothorax recurrence had been eliminated.