摘要
目的 探讨食管癌术后乳糜胸的原因及治疗方法。方法 分析 8例食管癌术后发生乳糜胸者的手术过程及术后引流量等相关指标。结果 本组 8例中 7例行主动脉弓上吻合 ,1例主动脉弓下吻合。术后病理均为鳞状细胞癌 ;其中T11例 ,T2 2例 ,T3 5例 ;N13例 ,N0 5例 ,M0 8例。术后引流量 2 4 1～ 16 4 1ml/d ,平均 5 82ml/d ,白蛋白总用量 0～ 5 2 0 g ,血浆总用量 4 0 0～ 10 0 0 0ml;5例行二次开胸胸导管结扎术治疗 ,两次手术间隔时间 12～34d。 3例保守治疗 ,胸腔注射重组人血白介素Ⅱ。全部病例均治愈。结论 肿瘤外侵处、主动脉弓后和弓上部位胸导管易受损伤 ,此为产生乳糜胸的主要原因 ,手术部位的良好显露在一定程度上可避免胸导管损伤。胸腔引流量平均在 30 0ml/d以上 ,保守治疗 1周无好转者 。
Objective To study the cause and treatment of postoperative chylothorax in esophageal cancer patients.Methods The operative procedure and postoperative thoracic drainage volume( PTDV ) of the patients with postoperative chylothorax were analyzed.The cause and treatment of postoperative chylothorax were sum up.Results Post lateral thoractomy was used in all 8 cases.Esophageal gastric layer by layer anastomoses were performed in all cases,The sites of anastomoses were above the aorta arch in 7 cases,and below the arch in 1 case.Post operative pathology was squamous carcinoma in 8 cases.TNM:T 1 1 case,T 2 2 cases,T 3 5 cases;N 0 5 cases,N 1 3 cases;M 0 8 cases.PTDV was 241～ 1 641 ml/d(mean:582 ml/day).Albumin:0～520g.The volume of plasma was 400～10 000ml.The time of surgical intervention from esophageal surgery was 12～34 days.Ligation of the thoracic duct was used in 5 cases;The treatment was conservative in 3 cases.all patients were discharged without recurrent chylothorax.Conclusions It was easy to damage the thoracic duct in the sites of invading,post and above aorta arch.It could avoid the thoracic duct damage by good exposure in a certain degree.PTDV was more than 300ml/day and lasted over one week,surgical intervention should be selected.
出处
《北京医学》
CAS
北大核心
2003年第3期176-178,共3页
Beijing Medical Journal
