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本院1975—1985年间共施行食管癌切除手术846例,发生乳糜胸17例,发生率为2.01％。乳糜胸发生于左侧7例,右侧6例,双侧4例。16例于术后3天内发生,仅1例于术后7天发生。本组17例均先行保守治疗,8例中转手术,保守治疗死亡1例,中转手术后死亡1例。作者认为在主动脉弓上下这一区域分离食管或肿瘤时,对所分离切断的组织,必须不厌其烦地一一结扎,一旦疑有损伤胸导管,应直视下将胸导管低位双重缝扎,是防止发生乳糜胸的重要措施。保守治疗有一定的试探性,对部分病例,长期保守治疗,将贻误病情。乳糜液引流日量多于500ml者应及时中转手术,是提高治愈率的关键。本组手术8例9次,全部由右胸入路,有简单快捷、效果确实的特点。本文并介绍了这一手术方法和注意事项。
From 1975 to 1985, 846 cases of esophageal cancer resection were performed in our hospital. There were 17 cases of chylothorax, and the incidence was 2.01%. The chylothorax occurred in 7 cases on the left side, 6 cases on the right side, and 4 cases on both sides. 16 cases occurred within 3 days after surgery, and only 1 occurred 7 days after surgery. In this group, 17 cases were treated conservatively first, 8 cases were treated with transfer surgery, 1 case was treated with conservative treatment, and 1 case died after transfer surgery. The authors believe that when separating the esophagus or tumor from the area above or below the aortic arch, the isolated and severed tissue must be tediously ligated one by one. Once the thoracic duct is injured, double suture of the thoracic duct should be performed under direct vision. The important measure of chylothorax. Conservative treatment has a certain tentative nature. For some cases, long-term conservative treatment will delay the disease. More than 500ml daily dose of chylous fluid should be promptly transferred to surgery, is the key to improving the cure rate. This group of surgery in 8 cases 9 times, all by the right chest approach, a simple and fast, the effect is indeed the characteristics. This article also describes this surgical method and precautions.