胸外科手术后继发乳糜胸的防治

乳糜胸是一种罕见且严重的胸外科手术并发症,导致患者严重的营养消耗、生理紊乱和免疫抑制,了解乳糜漏的病理生理学是治疗原则的基础。保守治疗旨在通过营养干预减少乳糜的产生,并通过乳糜液引流控制症状,终点是淋巴管的自发闭合。手术干预的时机仍然存在争议,胸腔镜胸导管夹闭以及栓塞已成为开放手术的替代方案。采取何种处理方法应根据患者自生情况判断和决定,过度强调手术及不适当的保守治疗都不是临床的最佳选择。本文对胸外科术后继发乳糜胸的治疗及预防现状和新的进展进行了综述。

Prevention and treatment of chylothorax in thoracic surgery

Chylothorax is a rare and serious complication after thoracic surgery, leading to severe nutritional consumption, physiological disorders and immunosuppression in patients. Understanding the pathophysiology of chylothorax is the basis of the management principle for chylothorax. Conservative treatment aims to reduce the production of chyle through nutritional intervention, and to control symptoms through chyle drainage, with the end point being the spontaneous closure of lymphatic vessels. The timing of surgical intervention is still controversial, and either ligation or embolization of thoracic ducthave become an alternative to open surgery. The treatment method to be adopted should be judged and decided according to the patient's own condition. Overemphasis on surgery and inappropriate conservative treatment are not the best clinical choice. This article only reviews the current status and new developments in the treatment and prevention of secondary chylothorax after thoracic surgery.