食管癌和肺癌术后乳糜胸的分析及比较

Analysis and comparison of postoperative chylothorax following esophagus cancer and lung cancer

目的 分析食管癌和肺癌术后乳糜胸的发生率、成因、治疗方法及预后并加以比较。方法 回顾性研究 1993年 1月 1日～ 2 0 0 3年 10月 31日接受手术治疗的食管癌和肺癌 15 32例和 2 887例。结果 食管癌术后乳糜胸为 13例 (发生率0 .85 % ) ,肺癌术后为 12例 (发生率 0 .4 2 % ) ;乳糜胸每日的中位引流量 ,食管癌为 180 0ml/天 ,肺癌为 6 5 0ml/天。食管癌术后乳糜胸的临床症状有呼吸困难、心悸、呼吸窘迫和休克 ,肺癌术后乳糜胸无特殊临床表现。食管癌术后乳糜胸保守治疗 8例 ,死亡 2例。再手术治疗 5例 ,死亡 1例。肺癌术后乳糜胸经保守治疗均痊愈。结论 食管癌术后乳糜胸的发生率高于肺癌 ,食管癌术后乳糜胸的量及临床表现比肺癌严重 ,食管癌术后乳糜胸预后差。食管癌术后乳糜胸应推荐早期手术治疗 。

Objective To analysis and compare the incidence, causes, management and prognosis of chylothorax after operation of esophagus cancer and lung cancer. Methods Restropective analysis of 1 532 patients with esophagus cancer and 2 887 patients with lung cancer who underwent operation between January 1993 and Octember 2003. Results Chylothorax occurred in 13 patients (0.85%) of esophagus cancer and in 12 patients (0.42%) of lung cancer. The mean duration of chylous drainage was 1 800 ml/day in esophagus cancer and 650 ml/day in lung cancer. The clinical manifestation of chylothorax after operation of esophagus were respiratory difficulty, palpitation and shock. The chylothorax after operation of lung cancer had no special clinical manifestation. Eight patients of chylothorax after operation of esophagus cancer were treated conservatively (two deaths) and five surgically (one death). The patients of chylothorax after operation of lung cancer were all treated conservatively. Conclusion The incidence of chylothorax after operation, the esophagus cancer predominate over lung cancer. The amount of chylothorax and clinicial manifestation, the esophagus cancer is more critical than lung cancer. The early re operation and ligation of thoracic duct seems to be advisable to patients of chylothorax after operation of esophagus cancer. The chylothorax after operation of lung cancer can be cured with a conservative strategy.