46例肺癌肺叶切除术后乳糜胸回顾性分析  

Retrospective analysis of chylothorax after lobectomy with lung cancer in 46 cases

作　　者：辛向兵 贾建博 卢强 赵晋波 韩勇 王涛 XIN Xiang-bing;JIA Jianbo;LU Qiang(Department of Thoracic Surgery,Tangdtt Hospital,Air Force Medical University,Xi＇an 710038,China)

机构地区：[1]空军军医大学唐都医院胸腔外科,西安710038

出　　处：《临床外科杂志》2018年第7期524-526,共3页Journal of Clinical Surgery

摘　　要：目的探讨肺癌肺叶切除术后乳糜胸的临床特点。方法肺癌行根治性切除并区域性淋巴结清扫术,术后并发乳糜胸病人46例。最初全部行禁食治疗,其中完全禁食29例,低甘油三酯饮食17例。禁食治疗失败者行乳糜胸的方法。结果胸膜固定术治疗,固定术治疗失败者行胸导管结扎术治疗。完全禁饮食组14例经饮食治疗成功治愈,15例行胸膜固定术;低甘油三酯饮食组7例经饮食治疗成功治愈,剩余10例病人,有3例改为完全禁饮食,还有7例改为行胸膜固定术。禁饮食组和低甘油三酯饮食组间,胸管引出量、住院时间、最初治疗的成功率比较,差异无统计学意义。22例行胸膜固定术病人,成功19例,3例病人进一步行手术结扎胸导管治疗。结论有效的保守治疗,包括胸膜粘连固定术,应该是复杂肺叶切除并纵隔淋巴结清扫术后并发乳糜胸有效管理的第一选择。Objective To explore clinical features of chylothorax after lobectomy of lung cancer.Methods Radical resection of lung cancer and regional lymph node dissection were performed in 46 patients with chylothorax. Initially,all patients were treated with fasting,including 29 cases with complete fasting and 17 cases with low triglyceride diet. Fasting cures losers were treated by chylothorax. Results Pleural fixation was performed for the patients,while the cure failure patients were treated by thoracic duct ligation. In the total diet group,14 cases were successfully cured by diet therapy,15 cases were treated with pleura fixation,and 7 cases in low triglyceride group were cured by diet therapy. The remaining 10 cases were 3 cases changed to complete diet,and 7 cases were replaced by pleura fixation. There was no significant difference between the diet group and the low triglyceride diet group in the volume of thoracic duct elicited,the time of hospitalization,and the success rate of the initial treatment（ P〉0. 05）. In 22 patients with pleural fixation,19 were successful,and 3 patients were further treated with thoracic duct ligation. Conclusion Effective conservative treatment,including pleuroparietopexy,should be the first choice for complex lobectomy and mediastinal lymph node dissection and postoperative chylothosax effective management.

关 键 词：肺癌 乳糜胸 禁食治疗 胸膜固定术 胸导管结扎术 

分 类 号：R734.2[医药卫生—肿瘤]