达芬奇机器人肺癌根治术后并发乳糜胸分析:附5例临床报告  

Clinical procedures for chylothorax secondary to radical operation for lung cancer via da Vinci surgical system: report on 5 cases

作　　者：李博[1] 刘星池[1] 徐惟[1] 丁仁泉[1] 王通[1] 孟浩[1] 王希龙[1] 许世广[1] 刘博[1] 王述民[1] 杨笑 

机构地区：[1]沈阳军区总医院胸外科,辽宁沈阳110016 [2]解放军第四六三医院护理部,辽宁沈阳110042

出　　处：《临床军医杂志》2016年第6期563-565,共3页Clinical Journal of Medical Officers

基　　金：辽宁省科技厅重点课题(面上项目)(2015020431)

摘　　要：目的探讨达芬奇机器人肺癌根治术后并发乳糜胸患者的诊断及治疗方案。方法自2011年10月至2015年12月,沈阳军区总医院胸外科应用达芬奇机器人手术系统(DVSS)行肺癌根治术治疗肺癌患者219例,其中,术后并发乳糜胸5例(发生率2.28%),均给予保守治疗。治疗措施包括:(1)夹闭胸引管;(2)胸腔内注射红霉素0.25 g+利多卡因0.1 g+浓糖20 ml;(3)皮下注射奥曲肽+胸腔内注入金葡素。结果全部219例患者均顺利完成手术,无中转开胸。术后5例并发乳糜胸患者的病理类型分别为2例鳞癌、3例腺癌,病理分期分别为Ⅰa期3例、Ⅱa期1例、Ⅲa期1例,清除淋巴结数分别为18枚(0/18,N0)、8枚(1/8,N1)枚、9枚(4/9,N2)、24枚(0/24,N0)及42枚(0/42,N0),平均(20.20±13.86)枚。经保守治疗后,4例治愈(治愈率80.00%),1例死亡(死亡率20.00%)。结论 DVSS肺癌根治术后出现乳糜胸时,及时诊断并选择恰当治疗,可取得良好的治疗效果,减少死亡率;另外,应特别注意患者淋巴结清扫过程中的副损伤。Objective To explore the diagnosis and therapeutic methods for the postoperative complication of chylothorax secondary to radical resection for lung cancer via da Vinci surgical system（ DVSS）. Methods Totally 219 cases of patients with lung cancer received DVSS since October 2011 to December 2015. There were 5 cases of chylothorax after the operation（ the incidence was2. 28%）,and all of them received conservative treatments,such as closed thoracic drainage tube,the chest cavity injection of erythromycin 0. 25 g ＋ lidocaine 0. 10 g ＋ 10% glucose 20 ml,subcutaneous injection of octreotide ＋ the chest cavity injection of staphylococcal enterotoxin C. Results All the 219 cases of surgeries were successfully completed,without thoracotomy. There were 5 cases of postoperative chylothorax,including 2 cases of squamous carcinoma and 3 cases of adenocarcinoma（ 1 case ofⅠa,1 case ofⅡa and 1 case of Ⅲa）.The numbers of removed lymph nodes were 18（ 0 /18,N0）,8（ 1/8,N1）,9（ 4/9,N2）,24（ 0/24,N0） and 42（ 0/42,N0）,with an average of（ 20. 20 ±13. 86）. Through conservative treatments,4 cases were cured,1 case died. The incidence of chylothorax was 5/219（ 2. 28%）,the cure rate was 4 /5（ 80%） and the mortality rate was 1 /5（ 20%）. Conclusion Postoperative chylothorax after radical resection of pulmonary carcinoma by DVSS is a timely diagnosis and proper treatment,which can achieve great treatment effect and reduce the mortality rate. Furthermore,in the process of lymphadenectomy,the patients with vice injury should be paid special attention.

关 键 词：达芬奇机器人 乳糜胸 肺癌 肿瘤根治术 

分 类 号：R735.37[医药卫生—肿瘤]