结扎胸导管预防不同部位胸段食管癌切除术后乳糜胸的疗效分析

目的分析术中结扎胸导管对不同部位胸段食管癌患者手术后预防发生乳糜胸的作用。方法对2003年3月至2007年6月手术切除的胸段食管癌243例患者的临床资料进行回顾性分析。根据不同病变部位将患者分为上段、中上段、中段、中下段和下段5组，了解不同部位胸段食管癌患者术中结扎和不结扎胸导管与术后乳糜胸发生有无相关性。结果术后共计8例患者出现乳糜胸，总发生率3．3％。上段病变结扎组乳糜胸发生3例，未结扎组5例；中上段病变结扎组和未结扎组均未发生乳糜胸；中段病变未结扎组1／28（3．6％）；中下段病变结扎组乳糜胸发生率1／39（2．6％），未结扎组1／35（2．9％）；下段病变结扎组乳糜胸发生率1／37（2．7％），未结扎组2／44（4．5％）。Logistic回归分析显示。不同部位胸段食管癌切除术中是否结扎胸导管结扎对术后乳糜胸的发生均无影响（P〉0．05）。结论预防性结扎胸导管不能降低不同部位胸段食管癌术后继发乳糜胸的发生率。     

食管癌切除术后乳糜胸的预防和治疗(附17例报告)

食管癌切除术中预防性结扎胸导管675例,术后乳糜胸5例,发生率0.75％,每日乳糜液量少于500ml,保守治疗治愈。未预防性结扎胸导管735例食管癌切除术,发生乳糜胸12例,发生率1.64％,乳糜液量大,8例二次手术治愈,1例术后因衰竭死亡。认为预防性结扎胸导管可降低乳糜胸的发生率。     

乳糜胸与术中胸导管预防性结扎

乳糜胸是食管癌切除术后最严重的并发症之一,我科自１９７８～１９９８年共施行食管癌切除术２１６２例,发生乳糜胸２５例（１．１５％）,术中行胸导管预防性结扎者乳糜胸发生率明显低于未行预防性结扎者。１临床资料与方法１．１一般资料和分组按时间顺序和不同的胸导...     

胸导管结扎预防食管癌术后乳糜胸

胸导管结扎预防食管癌术后乳糜胸张安庆，董正，刘正光，林刚，李伟食管癌术后乳糜胸是一种不十分罕见的并发症，且后果严重。国内大量临床资料统计，其发生率为０．４％～２．６％，主要发生在中上段食管癌术后［１］。是否应当在食管癌手术中结扎胸导管预防术后乳糜胸尚...     

结扎胸导管预防不同部位胸段食管癌切除术后乳糜胸的疗效分析

目的 分析术中结扎胸导管对不同部位胸段食管癌患者手术后预防发生乳糜胸的作用.方法 对2003年3月至2007年6月手术切除的胸段食管癌243例患者的临床资料进行回顾性分析.根据不同病变部位将患者分为上段、中上段、中段、中下段和下段5组,了解不同部位胸段食管癌患者术中结扎和不结扎胸导管与术后乳糜胸发生有无相关性.结果 术后共计8例患者出现乳糜胸,总发生率3.3%.上段病变结扎组乳糜胸发生3例,未结扎组5例;中上段病变结扎组和未结扎组均未发生乳糜胸;中段病变未结扎组1/28(3.6%);中下段病变结扎组乳糜胸发生率1/39(2.6%),未结扎组1/35(2.9%);下段病变结扎组乳糜胸发生率1/37(2.7%),未结扎组2/44(4.5%).Logistic回归分析显示,不同部位胸段食管癌切除术中是否结扎胸导管结扎对术后乳糜胸的发生均无影响(P》0.05).结论 预防性结扎胸导管不能降低不同部位胸段食管癌术后继发乳糜胸的发生率.     

常规胸导管结扎预防食管癌术后乳糜胸

常规胸导管结扎预防食管癌术后乳糜胸李志明税跃平廖斌乳糜胸是中上段食管切除术后的严重并发症之一。其发生率为０．４％～２．６％［１］。我院自１９８９年以来，对２０６例中上段食管癌手术切除患者，常规施行预防性胸导管结扎，术后无１例发生乳糜胸，有效地防止了这...     

不同方法结扎胸导管预防食管癌术后乳糜胸

乳糜胸是食管癌术后严重的并发症之一，发生率0．4％～2．6％。术中是否预防性结扎胸导管，各家意见不一致。我科自1977年6月～2003年9月切除食管癌2943例，发生乳糜胸28例(0．95％)。不结扎胸导管1102例。术后发生乳糜胸21例(1．9％)；术中预防性结扎胸导管1841例，术后发生乳糜胸7例(0．38％)。发生率明显下降，现就本组结果分析如下。     

食管癌切除术并发胸导管损伤的早期诊断及治疗

我院1990年至1993年共施行食管癌切除术160例，术中胸导管损伤5例，发生率为2．1％，5例中3例于术中发现并及时处理，未发生乳糜胸，另2例于术后并发乳糜胸才诊断，经早期剖胸手术治愈,本文介绍了食管癌切除术并发胸导管损伤的早期诊治体会。     

常规胸导管结扎预防食管癌术后乳糜胸

作者对202例中、上段食管癌病人术中常规行胸导管主干结扎术，术后无乳糜胸发生。讨论了胸导管的应用解剖，认为只要熟悉胸导管的解剖，无论使用何种方法，术中行胸导管结扎并不困难。最后认为，胸导管结扎是预防术后乳糜胸发生的有效方法，应此起重视。     

食管癌术后乳糜胸的治疗

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。     

Prophylactic Thoracic Duct Mass Ligation Prevents Chylothorax After Transthoracic Esophagectomy for Cancer

Background  Chylothorax after transthoracic esophagectomy for cancer is an uncommon but potentially life-threatening postoperative complication. It has been reported that preventive thoracic duct ligation can reduce the incidence of postoperative chylothorax after esophagectomy for cancer. In this prospective series, we evaluated the results of preventive intraoperative thoracic duct mass ligation in patients who underwent transthoracic esophagectomy for cancer. Methods  From 2001 to 2006, 323 patients underwent transthoracic esophagectomy for cancer and duct ligation during the operation was routinely performed. Results  No intraoperative or postoperative complications directly related to the procedure were recorded. No postoperative chylothorax was observed. Conclusions  In this series, the technique of intraoperative thoracic duct mass ligation proved to be safe and effectively prevented postoperative chylothorax in patients who underwent transthoracic esophagectomy for cancer.     

食管癌二次手术19例原因分析

目的：探讨食管癌行二次手术的原因及防治措施。方法回顾性分析2000年1月至2012年12月间北京大学肿瘤医院单一手术组施行的946例食管癌手术患者的临床资料,其中19例因术后严重并发症需行二次手术,总结该19例患者的临床特点及治疗经过。结果19例二次手术的患者中因术后胸腔内出血行开胸止血术4例,因膈疝行膈疝还纳、膈肌修补术4例,因乳糜胸行胸导管结扎术4例,因腹部切口裂开行切口缝合术4例,因创伤性胰腺炎行胸腹腔探查、腹腔置管引流术1例,因肠梗阻行回盲部切除、回肠造瘘术1例,因双侧喉返神经麻痹行气管切开术1例。19例二次手术患者全部治愈,无围手术期死亡和再次并发症发生。结论食管癌术后再次手术常见原因主要为术后出血、膈疝、乳糜胸和腹部切口裂开。     

Intraoperative fluorescence lymphography using indocyanine green in a patient with chylothorax after esophagectomy: report of a case

We report a case of chylothorax treated successfully by a new diagnostic tool: indocyanine green (ICG) fluorescence lymphography. The patient, a 65-year-old man with adenocarcinoma of the esophagogastric junction, underwent radical esophagectomy, which was followed by the development of chylothorax. On postoperative day 10, we performed transabdominal ligation of the thoracic duct. During the re-operation, we injected ICG into the mesentery of the small bowel. We then performed mass ligation of the tissue right and dorsal of the aorta, including the thoracic duct, after which a near-infrared camera system revealed a fluorescent stripe on the caudal part of the ligation. The remnant thoracic duct appeared to be dilated as a result of lymphatic stasis. The patient was discharged 35 days after his initial surgery. We report this case to demonstrate the usefulness of intraoperative ICG lymphography as a tool to identify and confirm ligation of the thoracic duct transabdominally.     

Chylothorax after thoracoscopic esophagectomy.

Among 30 patients who underwent thoracoscopic esophagectomy with lymphadenectomy for thoracic esophageal cancer, from July 1995 to May 1997, chylothorax developed in 2 patients (7%). In Case 1, the ligation of the thoracic duct under conventional right thoracotomy was performed on the 9th day after esophagectomy. After ligation, the pleural effusion was decreased, and the patient was discharged from hospital on the 25th day after the second operation. In Case 2, massive pleural effusion developed on the 10th day after esophagectomy (at 3 days after thoracic drainage tube was removed). The thoracic duct was ligated at the level just cranial to the diaphragm thoracoscopically on the 14th day after esophagectomy. The patient was discharged from hospital on the 30th day after the second operation. Injury to the thoracic duct due to a magnification effect of the view of scopic surgery remains a pitfall in thoracoscopic esophagectomy. But thoracoscopic ligation of thoracic duct was effective and safe for these two cases of chylothorax after esophagectomy.     

Chylothorax after cardiothoracic surgery

8 patients with postoperative chylothorax were reported: 7 after resection of esophageal carcinoma, 1 after radical correction of tetralogy of Fallot. 1 case was treated conservatively and 7 by ligation of thoracic duct after rethoracotomy. All the cases recovered. The factors causing postoperative chylothorax, the principles of treatment, and the role of prophylactic ligation of thoracic duct were discussed. The authors point out that, the mechanisms of postoperative chylothorax after open heart surgery by sternotomy may be: (1) injury of perithymotic and anterior mediastinal lymph ducts; (2) injury of thoracic duct through posterior wall of pericardium; and (3) effect of hypertension of systemic veins on flow of thoracic duct.     

Thoracoscopic management of chylothorax complicating esophagectomy

BACKGROUND: Chylothorax is a relatively uncommon complication of esophageal surgery that may lead to severe respiratory, nutritional, and immunologic deficiencies. PATIENTS AND METHODS: Between 1992 and 2000, 3 of 316 patients (0.9%) undergoing transthoracic esophagectomy for carcinoma developed postoperative chylothorax. Two of them had previously been treated with neoadjuvant chemoradiation, and one had been submitted to esophagogastric resection through a left thoracotomy. After a 2-week trial of total parenteral nutrition and drainage, two patients underwent thoracic duct ligation via thoracotomy. In the last patient, the operation was completed by thoracoscopy. The azygos vein and the periaortic tissue above the diaphragm were encircled en bloc by a right-angled clamp, and a roticulating endostapler was applied. RESULTS: Reoperation was successful in all patients. The postoperative hospital stay was 4 days. CONCLUSION: Thoracoscopy is a safe and effective procedure for the treatment of chylothorax complicating esophagectomy. Given the minimal trauma to the patient, early thoracoscopic reoperation can be advocated in patients with high-output chyle loss in order to reduce the hospital stay.     

Results of prophylactic thoracic duct ligation in advanced esophageal carcinoma

Objective  Esophageal carcinoma is one of the most common lethal malignancies in northwest Iran. The purpose of this study is to determine the efficiency of prophylactic thoracic duct ligation and compare the incidence, risk factors and outcomes of chylothorax in patients undergoing esophageal cancer surgery. Methods and Material  From 1995 through 2005 a total 420 patients undergoing esophageal resection with or without mediastinal lymph node dissection. In first five years (Group I: 210 patients) that after any esophagectomies we have not used prophylactic thoracic duct ligation (1995–2000). In last five years for prevention of chylothorax after any esophagectomies (Group II: 210 patients), thirty patients with advanced stage of esophageal carcinoma underwent to prophylactic thoracic duct ligation (2000–2005). Data analysis included Chi-square or Fisher exact test and Independent Samples t test. A p-value of <0.05 was considered significant. All analyzes were performed using the SPSS.15/_win software. Results  There were 100 men and 110 women with a mean age of 53.18±12.35 years in Group I, 108 men and 102 women with a mean age of 56.1±9.83 years in Group II. The initial procedures were transhiatal esophagectomies and transthoracic esophagectomies. Six patients of group I, developed to chylothorax with average daily postoperative drainage greater than 1000 ml/day for 6 days, and underwent to reoperation at a mean of 7.12±1.85 days after diagnosis (4–8 days). Chest tube drainage was stopped during 48 hours after reoperation. In Group II chylothorax did not occur. Conclusions  Chylothorax increases mortality and duration of hospitalization after esophageal cancer surgery. Most cases of chylothorax after esophageal resection are cured with early surgical intervention. It could be concluded that prophylactic thoracic duct ligation reduce the occurrence of chylothorax in advanced cases of esophageal carcinoma.     

LOW THORACIC DUCT LIGATION FOR POSTOPERATIVE CHYLOUS EFFUSIONS IN INFANTS AND CHILDREN

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three-month-old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic duct ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.     

Low thoracic duct ligation for postoperative chylous effusions in infants and children.

Three patients aged from three months to six years underwent thoracic duct ligation at the level of the diaphragm for chylothorax which occurred following cardiac operations. Another three-month-old patient underwent thoracic duct ligation for massive postoperative chylopericardium. Indications for operation were a large recurrent chyle accumulation or prolonged chyle drainage. Operative ductograms to deliniate the cisterna chyli and to exclude the presence of multiple lymph channels were performed in three patients. Excellent postoperative results were obtained in all patients for periods of up to two years. Low thoracic dust ligation is a reliable means of control of postoperative chylothorax and lengthy persistence with conservative treatment is no longer necessary.