生长抑素辅助治疗肺癌根治术后乳糜胸

Effect of adjuvant therapy of somatostatin on postoperative chylothorax after radical resection of lung cancer

目的探讨生长抑素在肺癌根治术后并发乳糜胸患者中的应用价值。方法接受肺叶切除/全肺切除+系统性淋巴结清扫术后出现乳糜胸的13例患者,在保守治疗基础上静脉微泵注入生长抑素(思他宁)3 mg+生理盐水50 ml,维持12 h,每日2次。观察胸腔积液引流量及肺复张等情况。维持5~7 d后,若引流量少于200 ml则开始进食,进食3 d后若胸腔积液量无明显增多,肺膨张良好并无积液残留,则停用生长抑素。结果 13例乳糜胸均治愈,无再次手术及死亡者,生长抑素使用时间5~11 d,禁食时间7~14 d。所有患者使用生长抑素治疗后第1日胸腔积液引流量即明显减少,与治疗前比较差异有统计学意义(P<0.017)。治疗第3日引流量继续减少,与治疗前及治疗后第1日比较差异均有统计学意义(P<0.017)。13例胸部伤口均于术后7~10 d愈合,无明显并发症,复查胸部X线片或CT未见胸腔包裹性积液,肺复张良好。随访6~12个月,13例均未出现支气管残端瘘。结论在保守治疗基础上加用生长抑素持续微泵滴注治疗肺癌根治术后并发乳糜胸患者疗效尚可。

Objective To evaluate the application of somatostatin in treating chylothorax after radical resection of pulmonary carcinoma.Methods Thirteen patients presented with chylothorax after undergoing lobectomy/pneumonectomy combined with systematic lymph node dissection.On the basis of conservative therapy,3mg of somatostatin(Stilamin)dissolved in50ml physiological saline was administered via micro-pump infusion for12h,twice daily.The drainage volume of thoracic fluid and lung recruitment were observed.Patients had access to feeding if the drainage volume<200ml for5to7d.After3-d feeding,the use of somatostatin was discontinued when the thoracic fluid volume was not significantly increased,the lung recruitment was excellent and no residual effusion was noted.Results Thirteen patients with chylothorax were recovered after conservative therapy with somatostatin.No repeated surgery was performed.No case died.The administration of somatostatin was ranged from5to11d.The fasting time was7to14d.For all patients,the drainage volume of thoracic fluid was significantly decreased at1d after somatostatin administration(P<0.017).At3d after use of somatostatin,the drainage volume of thoracic fluid was further reduced,significantly less compared with that at1d after somatostatin administration(P<0.017).The chest wound was healed at postoperative7-10d in13cases.No evident postoperative complications were observed.Check X-ray or CT scan revealed no signs of thoracic encapsulated fluid.Excellent lung recruitment was noted.During6-12months follow-up,no patient presented with bronchopleural fistula.Conclusion Conservative therapy combined with continuous micro-pump infusion of somatostatin is an efficacious approach for treating postoperative chylothorax following radical resection of pulmonary carcinoma.