肺癌术后乳糜胸的诊断和营养治疗研究进展

Research progress in diagnosis and nutritional treatment of postoperative chylothorax in lung cancer

乳糜胸是肺癌根治术后常见的并发症。肺癌术后乳糜胸可导致血清白蛋白、免疫球蛋白、脂溶性维生素、矿物质、免疫细胞及免疫因子等大量丢失,导致患者出现蛋白质-能量营养不良、脂溶性维生素缺乏、电解质紊乱、严重感染等并发症,且死亡率高,需要及时正确的干预。乳糜胸的诊断目前仍缺乏统一标准,治疗手段也较为繁多。近年来,乳糜胸的一线治疗措施为营养治疗这一观点越来越受到认可,但营养治疗存在多种途径,包括特殊自然饮食、口服营养补充、肠内营养、补充性肠外营养和全肠外营养等。本文针对肺癌术后乳糜胸的诊断标准、定位诊断方法、多种治疗手段等进行综述,并重点对营养治疗的最新研究进展和方法进行综述,同时阐述不同营养治疗方法的优势和存在的问题,并提供便于临床实践的不同营养方案的多种实现办法,为临床进一步开展规范治疗、改善患者营养状况、加速乳糜胸痊愈提供依据。

Chylothorax is a common complication after radical surgery for lung cancer.Chylothorax after lung cancer surgery can lead to a large loss of serum albumin,immunoglobulin,fat soluble vitamins,minerals,immune cells and immune factors,resulting in protein energy malnutrition,fatsoluble vitamin deficiency,electrolyte disorder,severe infection and other complications.The mortality rate is high,and timely and correct intervention is needed.The diagnosis of chylothorax still lacks a unified standard,and there are various treatment methods for chylothorax.In recent years,the view that the first line treatment for chylothorax is nutritional therapy has become increasingly recognized.However,there are various ways and means of nutritional therapy,including special natural diet,oral nutrition supplementation,enteral nutrition,supplementary parenteral nutrition,and total parenteral nutrition.This article reviews the diagnostic criteria,localization diagnostic methods,and various treatment methods for postoperative chylothorax in lung cancer,with a focus on the latest research progress and methods of nutritional therapy.It also elaborates on the advantages and problems of different nutritional therapy methods,and provides multiple implementation methods for different nutritional regimens,providing reference for further standardized treatment in clinical practice,improving patient nutritional status,and accelerating the recovery of chylothorax.