肺癌切除术后乳糜胸的早期诊断和治疗  

Early diagnosis and treatment of postoperative chylothorax after lung carcinoma surgery

作　　者：薛志强[1] 温佳新[1] 刘毅[1] 任志鹏[1] 王彬[1] 张成伟[1] 刘阳[1] 初向阳[1] Xne Zhiqiang Wen Jiaxin Liu Yi Ren Zhipeng Wang Bin Zhang Chengwei Liu Yang Chu Xiangyang(Department of Thoracic Surgery, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]中国人民解放军总医院胸外科,北京100853

出　　处：《中华肺部疾病杂志（电子版）》2017年第4期395-397,共3页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：国家自然科学基金资助项目(81573026)

摘　　要：目的探讨肺癌切除术后乳糜胸的早期诊断和治疗。方法回顾性分析2009年1月至2013年12月我院胸外科肺癌切除术后并发乳糜胸患者的临床病理资料,并比较常规开胸与胸腔镜手术后乳糜胸的差别。结果 3 479例肺癌切除患者术后并发乳糜胸12例(0.34%,12/3 479),胸腔镜手术组的发生率为0.41%(7/1 719),开胸手术组为0.28%(5/1 760),两者之间未见统计学显著性差异(P>0.05)。11例(91.7%)采用保守治疗,1例(8.3%)再次手术行胸导管结扎后,全部恢复顺利。胸腔镜手术组乳糜胸患者的手术时间(207±29.1)min、平均出血量(142.9±60.7)ml、清扫淋巴结数(20.1±5.7)枚、带胸管时间(13.9±4.9)d、住院时间(26.7±5.7)d,与开胸手术组乳糜胸患者的手术时间(192±72.2)min、平均出血量(220.0±109.5)ml、清扫淋巴结数(14.4±4.5)枚、带胸管时间(13.2±7.8)d、住院时间(27.0±8.7)d相比,未见统计学有显著性差异(P>0.05)。结论乳靡胸是肺癌术后的一种少见并发症,与手术方式无关,多数可采用保守措施治愈。Objective To explore the early diagnosis and treatment of postoperative chylothorax after lung carcinoma surgery. Methods The clinical data of patients with postoperative chylothorax after lung cancer surgery from January 2009 to December 2013 were retrospectively analyzed, the difference between the videoassisted thoracoscopy surgery （VATS） and thoracotomy was compared. Results Twelve patients with postoperative chylothorax were identified among 3 479 patients who underwent lung carcinoma surgery （0.34%, 12/3 479）. Proportion of postoperative chylothorax was 0.41% in VATS group （7/1 719） and 0.28% in tboraeotomy group （5/1 760）, the difference was not significant （P〉 0.05 ）. 11 patients with postoperative chylotborax received conservative therapy, and 1 patient underwent thoracic duct ligation, all patients recovered smoothly. Comparing the VATS with the thoracotomy groups, the mean operative time was 207± 29.1 min vs. 192±72.2 min, with no significant difference （P〉0.05） ; and the average blood loss was 142.9±60.7 ml vs. 220.0± 109.5 ml, with no significant difference （P〉0.05）. Comparing the two groups of patients data, the number of lymph node dissection： 20.1±5.7 in VATS group and 14.4±4.5 in the thoracotomy group on average, with no significant difference （P〉0.05） ; postoperative drainage time： 13.9±4.9 days in the VATS group and 13.2±7.8 days in the thoracotomy group on average, with no significant difference （P〉 0.05 ） ; hospital stay： 26.7±5.7 days in the VATS group and 27.0±8.7 days in the thoracotomy group on average, with no significant difference （P 〉 0.05 ）. Conclusions Postoperative chylothorax is a rare complication of lung carcinoma resection. The incidence of postoperative ehylothorax is not related with operation type. The prognosis is good of chylothorax by early diagnosis and effective conservative treatment.

关 键 词：支气管肺癌 乳糜胸 外科手术 诊断/治疗 

分 类 号：R563[医药卫生—呼吸系统]