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目的探讨食管贲门癌术后乳糜胸的诊断治疗方法及预防措施。方法回顾性研究1987年9月至2011年12月3589例食管贲门癌患者手术后的临床资料,术后发生乳糜胸23例。结果拒绝二次手术衰竭死亡1例,发现不及时死亡1例,保守治疗治愈5例,手术治愈16例。结论食管贲门癌术后,胸液量达到或超过500 ml/d,应高度怀疑乳糜胸。一经确诊应积极进行实验性治疗和术前准备。保守治疗2 d效果不佳,或胸液量>1000 ml/d者则应立即进行手术治疗。食管肿瘤局部浸润严重者或可疑胸导管损伤者,行预防性胸导管结扎术是必要的。
Objective To investigate the diagnosis and treatment of chylothorax after esophageal and cardiac cancer and its preventive measures. Methods The clinical data of 3589 patients with esophageal and cardiac cancer after operation from September 1987 to December 2011 were retrospectively reviewed. There were 23 cases of chylothorax occurred after operation. Results 1 case of secondary surgical failure was rejected, 1 case was found not to be dead in time, 5 cases were cured by conservative treatment and 16 cases were cured by surgery. Conclusions Postoperative esophageal and cardiac cancer, pleural fluid volume reached or exceeded 500 ml / d, should be highly suspected chylothorax. Once confirmed, should be actively experimental treatment and preoperative preparation. Conservative treatment 2 d ineffective, or pleural fluid volume> 1000 ml / d should be immediately operated on. Esophageal cancer in patients with severe or suspicious thoracic duct injury, line prophylactic thoracic duct ligation is necessary.