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目的探讨食管癌术后乳糜胸的治疗方法和效果。方法回顾分析湖北医药学院附属襄阳一医院684例食管癌术后并发乳糜胸18例患者的临床资料,其中男12例,女6例;年龄57.5(38～66)岁。食管上段癌2例,食管中段癌15例,食管下段癌1例。所有患者均行左胸径路食管癌根治术,术中均未见明确的胸导管损伤,未行预防性胸导管结扎。结果 18例均先行保守治疗,10例痊愈;再手术治疗8例,手术时间60～90 min,术后无感染等并发症发生,住院时间8～10 d;7例治愈,1例死于术后吻合口瘘。17例治愈患者3个月后复查无乳糜胸再发。结论食管癌术后乳糜胸患者有必要早期行10 d严格、正规的保守治疗,经保守治疗后乳糜液量仍>800 ml/d者应及时再手术治疗,手术方式以右胸径路、膈上低位胸导管结扎术为宜。
Objective To investigate the treatment and effect of chylothorax after esophageal cancer surgery. Methods The clinical data of 684 patients with esophagectomy and chylothorax after operation in Xiangyang First Affiliated Hospital of Hubei Medical College were retrospectively analyzed. There were 12 males and 6 females, aged 57.5 (38-66 years). Upper esophageal cancer in 2 cases, mid-esophageal cancer in 15 cases, lower esophageal cancer in 1 case. All patients underwent radical thoracotomy for esophageal cancer without definite thoracic duct injury and no preventive thoracic duct ligation. Results 18 cases were treated conservatively and 10 cases were cured. Eight cases were treated by reoperation. The operation time was 60-90 minutes. No complications such as infection occurred after operation. The hospitalization time was 8-10 days. Seven cases were cured and one died of operation After anastomotic fistula. Seventeen patients were cured without recurrence of chylothorax after 3 months. Conclusions Patients with chylothorax after esophagectomy are required to undergo strict and formal conservative treatment 10 days early. After conservative treatment, chylous fluid volume> 800 ml / d should be re-treated in time. The operation mode is right-foot path, Low thoracic duct ligation is appropriate.