| 胸腔镜肺癌术后22例乳糜胸诊治体会 |
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| 引用本文： | 方明,张荣新,方寅,任自学,张干,田锐. 胸腔镜肺癌术后22例乳糜胸诊治体会[J]. 中华全科医学, 2019, 17(8): 1265-1267. DOI: 10.16766/j.cnki.issn.1674-4152.000917 |
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| 作者姓名： | 方明 张荣新 方寅 任自学 张干 田锐 |
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| 作者单位： | 1. 芜湖市第一人民医院胸外科, 安徽 芜湖 241000; |
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| 基金项目： | 国家自然科学基金项目(81502323) |
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| 摘 要： | 目的对胸腔镜肺癌术后乳糜胸患者进行分析,比较单孔及多孔胸腔镜术后乳糜胸的差别,总结胸腔镜肺癌术后并发乳糜胸的诊治体会。方法回顾性分析2015年5月-2018年5月安徽省肿瘤医院收治的1305例行胸腔镜肺癌手术患者,术后并发乳糜胸患者22例的临床资料。结果1305例胸腔镜肺癌手术患者中,术后并发乳糜胸22例(1.69%),男性9例,女性13例;年龄36-79岁,平均年龄66岁;单孔术式926例,术后乳糜胸17例(1.84%),右侧12例,左侧5例,右上叶肺癌5例,右中叶肺癌1例,右下叶肺癌6例;左上叶肺癌2例,左下叶肺癌3例;多孔术式379例,术后乳糜胸5例(1.32%),右上叶肺癌1例,右下叶肺癌3例,左下叶肺癌1例;两者之间差异无统计学意义(P>0.05)。22例患者均治愈,21例经营养支持、胸膜固定等措施保守治疗治愈,1例保守治疗2天后效果不确切,后经胸腔镜下手术结扎胸导管主干治愈,总治愈率为100%(22/22).结论单孔、多孔胸腔镜肺癌术后乳糜胸的发生率差异无统计学意义,胸腔镜肺癌术后乳糜胸的诊断并不困难,发生乳糜胸后应采取及时正确的治疗,多数乳糜胸可采取保守治疗治愈,对于保守治疗效果不确切或患者本身对营养丢失耐受差者应果断选择手术治疗,总体治疗效果满意。
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| 关 键 词： | 胸腔镜 肺癌 乳糜胸 诊断治疗 |
| 收稿时间： | 2018-11-24 |
Diagnosis and treatment of 22 cases of chylothorax after thoracoscopic lung cancer operation |
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| Affiliation: | Department of Thoracic Surgery, the First People's Hospital of Wuhu, Wuhu, Anhui 241000, China |
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| Abstract: | Objective To analyze clinical diagnosis and treatment of 22 patients with thoracoscopic lung cancer complicated with chylothorax, compare the difference of chylothorax after Single-operated thoracoscopic and multi-hole thoracoscopic surgery, and summarize the diagnosis and treatment of chylothorax after thoracoscopic lung carcinoma surgery. Methods The clinical data of 22 patients with chylothorax after thoracoscopic lung cancer surgery in 1 305 cases from May 2015 to May 2018 were retrospectively analyzed. Results A total of 22 patients with postoperative chylothorax were identified among 1 305 patients who underwent thoracoscopy lung carcinoma surgery (1.69%), with 9 males and 13 females, aged 36-79 years old with an average age of 66 years old; 17 cases of chylothorax after single-operated thoracoscopic surgery in 926 cases (1.84%), 12 cases on the right side, 5 cases on the left side； 5 cases on the right upper lobe lung cancer, 1 case on the right middle lobe lung cancer, 6 cases on the right lower lobe lung cancer, 2 cases on the left upper lobe lung cancer, 3 cases on the left lower lobe lung cancer；and 5 cases of chylothorax after multi-operational thoracoscopic surgery in 379 cases (1.32%), 1 case of right upper lobe lung cancer, 3 cases of right lower lobe lung cancer, 1 case of left lower lobe lung cancer； the difference was not significant (P＞0.05). And 22 patients were cured,21 cases cured by conservative treatment with nutrition support and pleural fixation, and 1 patient was cured by the thoracic ligation of the thoracic duct trunk with the effect which was not accurate after 2 days conservative treatment, with a total cure rate 100% (22/22). Conclusions There was no significant difference in chylothorax after single and multi-operational thoracoscopic for lung cancer. The diagnosis of chylothorax after thoracoscopic lung cancer is not difficult. The correct treatment should be taken after the occurrence of chylothorax. Most chylothorax can be cured by conservative treatment. Surgical treatment should be decisive for patients with inconsistent conservative treatment or poor tolerance to nutritional lose. The overall therapeutic effect was satisfactory. |
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| Keywords: | Thoracoscopy Lung cancer Chylothorax Diagnosis and treatment |
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