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目的观察术前口服牛奶联合改良胸导管结扎预防食管癌切除术后乳糜胸的效果。方法将行单一手术开放三切口食管癌切除术患者236例,随机分为A组120例和B组116例。2组术中均予以改良型胸导管结扎(预防性胸导管结扎联合选择性胸导管结扎)。A组120例术前6～8 h口服300～500 ml全脂牛奶,B组116例术前未口服牛奶或其他脂类饮品。评价术前口服牛奶联合改良型胸导管结扎其手术中的安全性、疗效及预后。结果236例均顺利完成手术,无术中死亡病例。A组无术中乳糜胸发生。B组发生术后乳糜胸6例(5.2%),4例保守治疗1～2周后自行好转,有2例治疗无效后手术,再次手术后1例乳糜胸得到控制,1例术后仍有乳糜胸同时并发吻合口瘘,综合保守治疗术2个月后好转出院。结论术前口服牛奶联合改良型胸导管结扎预防食管癌切除术后乳糜胸的方法安全有效,技术的改进和远期效果评价有待进一步研究探讨。
Objective To observe the effect of preoperative oral administration of milk combined with modified thoracic duct ligation in preventing chylothorax after esophageal resection. Methods A total of 236 patients with triple-incision esophagectomy undergoing a single operation were randomly divided into group A (120 cases) and group B (116 cases). Two groups of intraoperative were modified thoracic duct ligation (prophylactic thoracic duct ligation combined with selective thoracic duct ligation). A group of 120 patients preoperative 6 ~ 8 h oral administration of 300 ~ 500 ml whole milk, B group 116 patients without preoperative oral administration of milk or other lipids. To evaluate the safety, efficacy and prognosis of preoperative oral milk combined with modified thoracic duct ligation. Results All 236 patients successfully completed the operation without any deaths. Group A without chylothorax occurred. In group B, 6 cases (5.2%) had postoperative chylothorax, and 4 cases improved on their own after 1 to 2 weeks of conservative treatment. Two cases were treated after treatment was ineffective. One case of chylothorax was controlled after reoperation and one case remained after operation At the same time chylothorax concurrent anastomotic fistula, comprehensive conservative treatment of 2 months after the discharge improved. Conclusions Preoperative oral administration of milk combined with modified thoracic duct ligation is effective and safe in preventing chylothorax after esophageal resection. Technical improvements and long-term evaluation of the results are yet to be further explored.