肺癌术后真假乳糜胸的鉴别诊断和治疗  

Differential diagnosis and treatment of chylothorax and pseudochylothorax after lung cancer surgery

作　　者：杨劼[1] 吴卓鹏 古卫权[1] 叶俊[1] 杨胜利[1] 王飞[1] 肖叶[1] 张小文[1] 赵宁 吴玲玲 刘冬生[2] Yang Jie;Wu Zhuopeng;Gu Weiquan;Ye Jun;Yang Shengli;Wang Fei;Xiao Ye;Zhang Xiaowen;Zhao Ning;Wu Lingling;Liu Dongsheng(Department of Thoracic Surgery,the First People's Hospital of Foshan,Foshan 528000,China)

机构地区：[1]广东省佛山市第一人民医院胸外科,佛山528000 [2]广东省佛山市第一人民医院统计室,佛山528000

出　　处：《中华胸心血管外科杂志》2022年第8期481-486,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的:探讨肺癌术后真性乳糜胸和假乳糜胸的鉴别诊断和不同的治疗方法。方法:分析2016年1月至2021年12月1584例非小细胞肺癌的手术患者的临床资料,发现21例真性乳糜胸和8例假性乳糜胸,分析比较其胸腔积液常规生化、乳糜试验、总胆固醇、甘油三酯、总胆固醇/甘油三酯比值,白细胞计数、细菌培养和治疗方法的不同。结果:肺癌术后真性乳糜胸发病率为1.3%,假性乳糜胸发病率为0.5%;右侧真性乳糜胸占80.9%%,明显高于左侧真性乳糜胸19.1%,差异有统计学意义(P<0.05)。假性乳糜胸均发生在右侧(100%)。真性乳糜胸和假性乳糜胸胸腔积液胆固醇、甘油三酯水平差异有统计学意义(P<0.05),假性乳糜胸的白细胞计数明显高于真性乳糜胸,差异有统计学意义(P<0.05)。两组治疗前胸腔引流量,术后引流时间以及术后住院时间差异有统计学意义(P<0.05)。真性乳糜胸保守治疗13例,成功率为61.9%,胸导管夹闭术8例,手术率为38.1%;假性乳糜胸全部进行保守治疗,成功率为100%。结论:遇到肺癌术后乳糜胸除了胸腔积液乳糜试验、常规生化检查,还需检测胸腔积液中的总胆固醇、甘油三酯、总胆固醇与甘油三酯比值,以鉴别真性乳糜胸和假性乳糜胸,胸腔积液中甘油三酯含量高的诊断为真性乳糜胸;胸腔积液中胆固醇/甘油三酯比值>1的诊断为假性乳糜胸,假性乳糜胸一般采用保守治疗。真性乳糜胸根据不同情况采用保守和手术治疗,如连续3天胸腔引流量>800 ml/天或者造成严重水电解质紊乱的,建议行经右胸腔镜胸导管夹闭术。Objective To explore the differential diagnosis and different treatment methods of chylothorax and pseudochylothorax after lung cancer surgery.Methods Clinical data of 1584 surgical patients with non-small cell lung cancer from January 2016 to December 2021 were analyzed,21 cases of chylothorax and 8 cases of pseudochylothorax were identified and analyzed to compare the differences in pleural fluid chyle test,pleural effusion biochemical values,total cholesterol,triglycerides,total cholesterol/triglyceride ratio,leukocyte count,bacterial culture and treatment.Results The incidence of chylothorax after lung cancer surgery was 1.3%,and the incidence of pseudochylothorax was 0.5%;80.9%%of chylothorax on the right side was significantly higher than 19.1%of chylothorax on the left side,and the difference was statistically significant(P<0.05).Pseudochylothorax occurred on the right side(100%).The difference between chylothorax and pseudochylothorax in pleural fluid tests for cholesterol and triglyceride was statistically significant(P<0.05),the leukocyte count was significantly higher in pseudochylothorax than chylothorax,and the difference was statistically significant(P<0.05).The differences in drainage before treatment,postoperative drainage time and postoperative hospitalization time between the two groups were statistically significant(P<0.05).The success rate was 61.9%in 13 cases of chylothorax treated conservatively and 38.1%in 8 cases of thoracic duct clamping;all cases of pseudochylothorax were treated conservatively with a success rate of 100%.Conclusion In naddition to pleural fluid chyle test and pleural effusion biochemical values,total cholesterol,triglyceride and total cholesterol to triglyceride ratio in pleural fluid should be tested to identify chylothorax and pseudochylothorax,high triglyceride in pleural fluid diagnosed as chylothorax;Pseudochylothorax is diagnosed with a cholesterol/triglyceride ratio>1 in the pleural fluid,pseudochylothorax is usually treated conservatively.Chylothorax is treated

关 键 词：非小细胞肺癌 真性乳糜胸 假性乳糜胸 鉴别诊断 治疗 

分 类 号：R734.2[医药卫生—肿瘤]