不同部位及手术方式对胸腔镜肺癌根治术并发乳糜胸的影响分析

Analysis of the effects of different sites and surgical approaches on thoracoscopic radical lung can⁃cer surgery complicated by celiac disease

目的 探讨不同部位及手术方式(肺段组与肺叶组、左侧与右侧组)对胸腔镜肺癌根治术并发乳糜胸的发生率、治疗和转归的影响。方法 回顾分析2015年1月~2021年12月中国科学院大学宁波华美医院收治2472例肺癌根治术后并发38例乳糜胸,其中肺段切除和肺叶切除各1236例,左侧胸腔镜肺癌根治手术952例,右侧胸腔镜肺癌根治手术1520例,肺段切除+系统性淋巴结根治并发16例乳糜胸,肺叶切除+系统性淋巴结根治并发22例乳糜胸,左侧胸腔镜肺癌手术后并发8例乳糜胸,右侧胸腔镜肺癌手术后并发30例乳糜胸的临床资料。结果 胸腔镜肺癌术后乳糜胸的总发生率为1.54%,肺段组术后乳糜胸的发生率为1.29%,肺叶组为1.78%,两者无显著差异(P=0.32)。左侧胸腔镜肺癌术后乳糜胸的发生率为0.63%,右侧胸腔镜肺癌术后乳糜胸的发生率为2.11%,两者有显著差异(P<0.001);所有病例均行保守治疗成功,无死亡病例。结论 肺癌术后乳糜胸的发生和肺癌手术部位明显相关,与手术方式无明显相关;肺癌术后乳糜胸的营养支持治疗使保守治疗的有效率不断提高。

Objective To investigate the effects of different parts and surgical methods of thoraco⁃scopic lung cancer(segment group and lobe group,left and right group)on the incidence,treatment and prognosis of chylothorax.Methods The clinical data of 38 cases of chylothorax after radical resec⁃tion of lung cancer in Ningbo Huamei Hospital of Chinese Academy of Sciences from January 2015 to December 2021 were retrospectively analyzed,including 1236 cases of segmental resection and 1236 cases of lobectomy,952 cases of left thoracoscopic radical resection of lung cancer,1520 cases of right thora⁃coscopic radical resection of lung cancer,16 cases of chylothorax after segmental resection and systemic lymph node radical resection,22 cases of chylothorax after lobectomy and systemic lymph node radical resection,8 cases of chylothorax after left thoracoscopic radical resection of lung cancer,and 30 cases of chylothorax after right thoracoscopic radical resection of lung cancer.Results The total incidence of chylothorax after thoracoscopic lung cancer surgery was 1.54%,the incidence of chylothorax in the lung segment group was 1.29%,and the lung lobe group was 1.78%.There was no significant difference between the two groups(P=0.32).The incidence of chylothorax after left thoracoscopic lung cancer was 0.63%,and the incidence of chylothorax after right thoracoscopic lung cancer was 2.11%,with significant difference(P<0.001).All cases were successfully treated with conservative treatment,no deaths.Conclusion The incidence of chylothorax after lung cancer surgery was significantly correlated with the surgical site of lung cancer,but not with the surgical method of lung cancer.Treatment outcome:nutritional support for postoperative chylothorax of lung cancer improves the efficiency of conservative treatment.