肺癌根治术后乳糜胸发生的相关因素分析  

Analysis of the related factors of chylothorax after radical resection of lung cancer

作　　者：张旭刚 李维青 李宝重 李志田 姜福胜 ZHANG Xu-gang;LI Wei-qing;LI Bao-zhong;LI Zhi-tian;JIANG Fu-sheng(Department of Thoracic Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院胸外科,北京100038

出　　处：《临床肺科杂志》2021年第5期752-756,共5页Journal of Clinical Pulmonary Medicine

摘　　要：目的综合评价肺癌根治术后乳糜胸的诊治及疗效。方法回顾性分析肺癌根治患者1473例的临床资料,并发乳糜胸者36例,分析乳糜胸发生的相关临床因素及临床特征。结果肺癌根治术后乳糜胸发生率为2.4%;乳糜胸组的男性(83.3%)、吸烟史(75.0%)、肺部疾病史(41.7%)、糖尿病史(44.4%)、鳞癌(55.6%)、N2站转移(30.6%)均较非乳糜胸组的高发(P<0.05)。乳糜胸组的右肺上叶切除术占比明显高于非乳糜胸组的(41.7%vs 27.8%P<0.05),Ⅱ/Ⅲ期患者明显多于非乳糜胸组(86.1%vs 32.3%P<0.05)。36例乳糜胸者胸水甘油三酯含量为123-1015 mg/dl,平均367.4±202.6 mg/dl;24小时胸引流量为320-1750 mL,平均823.3±516.5 mL。保守组与手术组比较,其胸水甘油三酯含量无明显差异,而24小时胸引流量明显低于后者(550.5 mL vs 1233.3 mL),带胸管天数明显少于后者(6.8d vs 13.2d)。结论对于右侧肺癌、男性、吸烟者、伴有肺部基础疾病或糖尿病者、N2站淋巴结较大者进行肺癌根治手术时,应当更加细致、谨慎的操作,避免乳糜胸的发生。乳糜胸多数经保守治疗可治愈,对于引流量>1000 mL/24 h,或化学性胸膜粘连治疗后持续5天未见好转者,建议积极手术干预。Objective To evaluate the clinical diagnosis and treatment of chylothorax after radical resection of pulmonary malignant tumor.Methods The clinical data of 1473 patients with radical resection of lung cancer were analyzed retrospectively,and 36 cases had postoperative chylothorax.The clinical factors and characteristics of chylothorax were analyzed.Results The incidence of chylothorax was 2.4%after radical resection of lung cancer.The incidences of chylothorax in men(83.3%),smoking history(75.0%),lung disease history(41.7%),diabetes history(44.4%),squamous cell carcinoma(55.6%),N2 station metastasis(30.6%)were higher than those without chylothorax(P<0.05).The right upper lobectomy in the chylothorax group was significantly higher than that in the non chylothorax group(41.7%vs 27.8%,P<0.05),and the patients at stageⅡ/Ⅲwere significantly more than those in the non chylothorax group(86.1%vs 32.3%,P<0.05).In 36 chylothorax patients,the content of triglyceride in pleural fluid was 123-1015 mg/dl,with an average of 367.4±202.6 mg/dl.The volume of pleural drainage was 320-1750 mL,with an average of(823.3±516.5)mL per 24 hours.There was no significant difference in the content of triglyceride in pleural fluid between the conservative group and the operation group,while the 24-hour chest drainage was significantly lower than the latter(550.5 mL vs 1233.3 mL),and the days with chest tube were significantly shorter than the latter(6.8 d vs 13.2 d).Conclusion For those with right lung cancer,men,smokers,basic lung diseases or diabetes,and those with large lymph nodes in N2 station,more careful and cautious operation should be carried out to avoid chylothorax.Chylothorax can be cured by conservative treatment.For those whose drainage volume is more than 1000 mL/24 h,or whose pleural fixation treatment lasts for 5 days without improvement,active surgical intervention is recommended.

关 键 词：肺癌 乳糜胸 胸膜固定术 胸导管结扎术 

分 类 号：R734.2[医药卫生—肿瘤]