选择性结扎胸导管在预防食管癌术后乳糜胸中的应用

目的:探讨选择性胸导管结扎在食管癌切除术中预防术后乳糜胸的作用.方法:将458例食管癌手术切除术病例分为3组.A组153例,术中均不结扎胸导管;B组147例,术中常规预防性结扎胸导管;C组为选择性结扎胸导管组共158例,术中结扎胸导管98例、未结扎60例.结果:术后发生乳糜胸A组8例(5.2%),B组和C组均为0例(0%);B组和C组相比较无统计学差异(P＞0.05),B组和C组与A组比较均有统计学差异(P＜0.05).结论:常规预防性和选择性结扎胸导管均可显著地降低食管癌术后乳糜胸的发生率;在食管癌切除术中,选择性结扎胸导管可预防术后乳糜胸发生.     

Imaging of postoperative complications following surgery for lung cancer

The complications following surgery for lung cancer vary depending upon the comorbidities and the type of surgery. Hemorrhage, infections and pulmonary edemas are not specific to the type of resection but frequently occur following pneumonectomies. Morbidity following pneumonectomies is related to the significant changes in the contents of the intrathoracic space. Pulmonary infarction and torsion are emergency situations that develop following lobectomy. CT shows features of localized congestion and stenosis or occlusion of a vein or bronchus. Rapid identification of severe events, in particular by systematic CT is essential for appropriate management of a postoperative or delayed complication of lung cancer surgery.     

肝硬化所致乳糜性胸水的临床分析——附4例报告

目的 探讨肝硬化所致乳糜性胸水的临床特点及诊断方法.方法 回顾分析我院2003年1月至2009年12月诊断4例肝硬化所致乳糜胸水的临床病例资料,分析其临床特点、诊断和治疗效果.结果 4例患者均携带有乙型肝炎病毒.胸水检查:外观为黄白色或白色乳糜状,实验室检查确诊为真性乳糜胸水(乳糜试验及苏丹Ⅲ染色均阳性).在综合治疗...     

Efficacy of octreotide against chylothorax following lateral neck dissection for thyroid cancer: A case report

IntroductionPostsurgical chylothorax is a rare complication of cervical dissection for thyroid cancer. We report that octreotide, a synthetic analog of somatostatin, is effective in treating chylothorax after thyroid carcinoma surgery.Presentation of caseThe patient was a 48-year-old woman who presented to our institution complaining of a left anterior cervical mass. We diagnosed this as thyroid papillary carcinoma and performed a subtotal excision of the thyroid gland with left cervical lymph node dissection. The patient developed dyspnea, and a chest X-ray revealed bilateral chylothorax on Day 4 post-surgery. Octreotide was administered since bilateral chylothorax was noted. A marked decrease in chyle effusion was noted just 3 days after starting octreotide, and after a total of 9 days of treatment, there were no further signs of chylous effusion.DiscussionOctreotide is effective against postsurgical chylothorax; however, if there are no signs of improvement, we believe surgical treatment should be considered.ConclusionOctreotide should be administered first to treat postsurgical chylothorax before surgical treatment is considered.     

食管癌术后乳糜胸发生原因与预防策略的临床分析

目的：研究并科学分析食管癌术（ Esophageal carcinoma）后乳糜胸（ Chylous hydrothorax）发生的原因与预防的相关策略,以期能够给食管癌术后乳糜胸患者提供最理想的治疗方案。方法采取回顾性的研究方法,在2012年11月～2014年11月,搜集在我市人民医院接受食管癌术的临床患者资料254例（明确记载有132例患者实施预防性胸导管结扎术,未明确记载有122例患者实施预防性胸导管结扎术）。把明确记载的132例患者分为治疗组,把未明确记载的122例患者分为未治疗组,再具体分析治疗组与未治疗组两组患者的食管癌术后发生乳糜胸的概率、术后的引流量等相关指标。结果132例治疗组的术后乳糜胸的发生率为0．76％,122例未治疗组的乳糜胸发生概率为9．02％。结论食管癌术后发生乳糜胸的原因一般为在切除食管癌的过程中损伤导管所致,实施预防性胸导管结扎术,可使食管癌术后乳糜胸的发生率明显降低。因此,需要在术中加强预防性胸导管结扎术。     

Intrapleural Bleomycin in the Treatment of Chylothorax

Summary

Chylothorax is an accumulation of thoracic lymph or chyle in the pleural cavity. It is a rare condition and is usually caused by trauma or malignant disease.

We present three cases with chylothorax due to malignant non-Hodgkin’s lymphoma [high grade malignant (1 case) and low grade malignant (2 cases)] treated with pleurodesis with bleomycin and systemic chemotherapy (CHOP, CNOP, trofosfamide). Complete remissions (CR) were achieved in all three cases. Two patients had a recurrent chylothorax 3 and 12 months after initial treatment. They were treated with a second intrapleural installation of bleomycin and continuing systemic chemotherapy (CNOP, trofosfamide) and are still alive in CR with a follow-up period of 28 and 30 months respectively. One patient died of relapsing non-Hodgkin's lymphoma after 23 months of follow-up. There was no sign of recurrent chylothorax.

We conclude that chylothorax caused by lymphoma can be satisfactorily controlled by pleurodesis with bleomycin combined with systemic chemotherapy. Immediate action is necessary to prevent great loss of lipids and proteins. The underlying malignancy must be controlled to achieve a good prognosis.     

14例新生儿先天性乳糜胸的护理

总结14例新生儿先天性乳糜胸的护理.护理要点包括:全胃肠外营养支持及喂养护理,保持胸腔闭式引流管的固定和通畅,胸腔内注射红霉素时监测生命体征,安抚哭闹患儿,预防感染和皮肤破损,加强疾病宣教.除1例家长要求自动出院外,其余13例均治愈.     

胸导管结扎在肺癌手术中应用的临床研究

目的探讨肺癌手术中行常规胸导管结扎的可行性及优越性。方法将80例肺癌手术患者随机分成研究组（胸导管结扎组）和对照组（不结扎胸导管）,两组均进行系统的淋巴结清扫。观察两组的术中术后情况及围手术期并发症发生情况,术前、术后1周分别进行血清载脂蛋白电泳,术前、术后2周、4周分别进行T细胞亚群测定,并进行统计学分析。结果两组比较,手术时间、失血量无显著性差异（P〉0．05）;术后乳糜胸的发生率无显著性差异（P〉0．05）;Ⅱ期、Ⅲa期患者胸腔引流量减少、带管时间及术后住院天数缩短（P〈0．05）;Ⅰ期患者两组术后胸腔引流量、带管时间、术后住院天数无显著性差异;两组手术前后血清载脂蛋白电泳以及手术前后T细胞亚群无显著性差异（P〉0．05）。结论肺癌手术中行胸导管结扎,不增加手术创伤,对术后肠道营养吸收及免疫功能的恢复没有影响,对于Ⅱ期Ⅲa期肺癌患者,行术中行胸导管结扎可以有效减少术后胸腔引流量,缩短术后住院时间。     

Chylothorax due to tuberculosis lymphadenopathy: Report of a case

While pulmonary tuberculosis is a very frequent infection, chylothorax is an unusual manifestation of tuberculous disease. A 71-year-old woman with chylothorax is herein presented. The ductus thoracicus was ligated and lymphadenomegaly, which was adjacent to diaphragm, was resected. Based on the findings of various tests, a diagnosis of tuberculosis lymphadenitis was made. The patient was administered antituberculosis chemotherapy and has since remained asymptomatic for 1 year after the operation. In conclusion, tuberculosis lymphadenomegaly may lead to the development of chylothorax. The combination of appropriate surgical and medical treatment is an effective therapeutic strategy for this pathology.