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。     

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...     

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。     

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。     

食管癌切除术后乳糜胸4例分析

食管癌切除术后乳糜胸４例分析山西医学院附属一院（０３０００１）张安庆，董正，林刚，李伟，马艳波食管癌切除术后乳糜胸是一种严重的并发症，国内外文献报道其发生率分别为０．４％～２．６％和１．８％～４．０％．不同部位吻合术后乳糜胸的发生牢尚无文献报道．如何...     

橄榄油标记胸导管预防腔镜下食管癌根治术后乳糜胸的发生

乳糜胸是食管癌术后的严重并发症,主要是由于传统开胸手术术前常禁食,乳糜液较透明,胸导管呈无色透明,因此术中难以被发现而易受损伤。目前常用的预防乳糜胸的方法为结扎胸导管。但有研究显示,结扎胸导管可导致淋巴淤滞,进而引起糖脂代谢紊乱。近年来,随着腔镜技术的发展,腔镜的放大性能有益于术中显露和保护胸导管。汕头市中心医院肿瘤外科自2012年10月至2014年1月间,在胸腹腔镜的基础上,对行食管癌切除术患者于术前晚予以口服橄榄油100～150 ml来标记胸导管,有效避免了乳糜胸的发生。现报道如下。     

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...     

腔镜食管癌切除术前口服橄榄油标示胸导管 减少术后乳糜胸的临床应用研究

目的:探讨腔镜食管癌切除术前口服橄榄油标示胸导管减少术后乳糜胸发生的可行性及临床效果。方法:回顾分析425例接受胸腹腔镜食管癌切除术患者的临床资料。其中观察组233例,于术前约8 h一次性服用食用橄榄油100～150 mL后禁食;对照组192例,术前不口服橄榄油。对比两组乳糜胸相关并发症发生率。结果:观察组术中胸导管损伤率、结扎率、术后乳糜胸发生率及乳糜胸相关二次手术发生率均低于对照组,差异有统计学意义。结论:腔镜食管癌切除术前口服橄榄油标示胸导管减少术后乳糜胸简单、可行,具有确切的临床效果,值得临床推广。     

食管癌根治胸导管结扎后并发乳糜腹一例

患者男,49岁.进行性吞咽困难4个月,胃镜检查见距门齿30cm以下食管环形肿物,黏膜中断、破坏,胃镜不能通过,病理活检结果为鳞状细胞癌.     

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。     

Prevention of postoperative chylothorax with thoracic duct ligation during video-assisted thoracoscopic esophagectomy for cancer

Background  

Minimally invasive esophagectomy (MIE) is a feasible technique that has been shown to be safe for the treatment of esophageal cancer. Chylothorax remains a challenging and potentially life-threatening postoperative complication of MIE. In this retrospective series, we evaluated the results of preventive intraoperative thoracic duct ligation in patients who underwent video-assisted thoracoscopic esophagectomy for cancer.     

Treatment of postoperative chylothorax through laparoscopic thoracic duct ligation.

We report the laparoscopic transhiatal thoracic duct ligation to solve postoperative chylothorax after right total pleurectomy for malignant diffuse mesothelioma.     

Thoracoscopic thoracic duct ligation for traumatic chylothorax

Traumatic chylothorax requires surgical intervention when conservative medical management fails to reduce chyle leakage. This usually entails thoracotomy or laparotomy. We report a case in which successful ligation of a torn thoracic duct was achieved using a video-assisted thoracoscopic technique.     

Treatment of chylothorax by robotic thoracic duct ligation

This is the first report describing the use of robotic technology for the treatment of chylothorax. We present a 22-year-old with mixed embryonal cell and seminoma germ cell cancer refractory to medical and surgical treatment. The patient had rising markers and a growing left lower lung lobe metastasis. After left lower lobectomy, left-sided chylothorax developed. Conservative management failed, and a robotic right-sided thoracic duct ligation was performed. Other treatment options are reviewed.     

Laparoscopic ligation of the thoracic duct in management of chylothorax

Laparoscopic ligation of the cisterna chyli at the level of the aortic hiatus was performed in a 69-year-old woman with post-lobectomy chylothorax refractory to 3 weeks of conservative therapy and one repeat thoracotomy with attempted ligation of a leaking lymphatic channel. This laparoscopic procedure was successful, and resolution of the chylothorax was achieved. We feel that this technique offers surgeons a valid, minimally invasive treatment option for a persistent chylothorax in which conservative management or more direct thoracic procedures have failed to control the chyle leak.     

Prone thoracoscopic thoracic duct ligation for postsurgical chylothorax

Background  Chylothorax after complex abdominal and thoracic procedures remains a challenging complication with a mortality rate reaching 50% if untreated [1]. Iatrogenic trauma accounts for almost 20% of all chyle leaks, and esophagectomy is the most common iatrogenic cause [2]. Consequences of ongoing chyle leak include dehydration, malnutrition, and immunocompromise. Methods  When nonoperative management techniques fail, prompt ligation of the thoracic duct at the diaphragmatic hiatus should be attempted. The authors present prone thoracoscopic thoracic duct ligation performed for two patients after laparoscopic transthoracic esophagectomy and revision paraesophageal hernia repair. Results  The prone position for thoracoscopic thoracic duct ligation offers several benefits to the surgeon. Gravity retracts the lung anteriorly, exposing the diaphragmatic hiatus. Single-lumen endotracheal intubation combined with low-pressure carbon dioxide insufflation efficiently collapses the lung to create ample working space. For the two reported patients, only three trocars were necessary to complete suture ligation of the thoracic duct via the right chest. Both patients had complete resolution of their chylothorax and recovered uneventfully. Based on this experience, the authors currently advocate early thoracoscopic treatment for cost and morbidity savings. Conclusions  The authors believe prone thoracoscopic thoracic duct ligation offers significant advantages to the patient in preventing the dangerous consequences of chyle leak in a timely, minimally invasive fashion. Importantly, the prone technique with carbon dioxide insufflation makes the technical challenges of thoracic duct ligation more facile for the surgeon. Electronic supplementary material  The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Early operative management of chylothorax by thoracic duct ligation

Chylothorax following mediastinal mobilisation for carcinoma of the oesophagus can be devastating, especially in malnourished, debilitated patients. Early surgical management in significant chylothorax (+ 500 ml/d) is suggested before nutritional degeneration occurs. Conservative management should be reserved for those patients who drain less than 500 ml/d.     

Surgery technique: preventive ligation of the thoracic duct during esophagectomy for cancer

Chylothorax is a rare but life-threatening complication of esophagectomy for cancer. Elective ligation of the thoracic duct above the diaphragm does not suppress completely the risk of chylothorax due to possible trauma of the thoracic duct wall at the level of ligation, or incomplete ligation in case of anatomic variation. This study describes a technique of preventive ligation "en block" with surrounding tissues in order to minimize the risk of chylothorax following oesophagectomy, whatever performed transthoracically or through transhiatal approach.     

膈上胸导管结扎术在食管癌切除术中的应用

目的探讨胸导管结扎术对食管癌术后乳糜胸的预防和治疗作用。方法回顾性分析我院2003年1月至2009年6月的两组共836例食管癌切除术后的乳糜胸发生情况和治疗效果。其中结扎组431例,术中常规在膈上水平整块结扎胸导管,非结扎组405例,术中未常规结扎胸导管,术后并发乳糜胸者,再次采用手术治疗。结果结扎组无术后乳糜胸发生。非结扎组术后发生乳糜胸15例（3．7％）,治愈13例（86．7％）,死亡2例（13．3％）,1例死于呼吸功能衰竭,1例死于多器官功能衰竭。结论食管癌切除术中常规结扎胸导管可有效预防术后乳糜胸的发生。膈上胸导管结扎法稳妥有效。食管癌术后并发乳糜胸应积极手术治疗。