胸腔镜术与开胸术治疗术后乳糜胸回顾性对比分析

目的探讨电视胸腔镜术治疗术后乳糜胸的临床价值。方法回顾性对比分析11例术后乳糜胸病人施行胸导管结扎术的临床资料，其中6例行开胸手术（开胸组），5例行VATS（VATS组）。结果所有病例均顺利完成胸导管结扎术，VATS组的手术时间明显较开胸组延长（P〈0．05），术中出血量明显少于开胸组（P〈0．05），手术切口的愈合时间（P〈0．05）、术后住院时间（P〈0．05）均较开胸组明显缩短。术后疼痛评分（P〈0．05）、术后强止痛药（吗啡）用量（P〈0．05）明显少于开胸组，胸管引流时间（P〉0．05）、胸管引流量（P〉0．05）、血常规恢复至正常时间（P〉0．05）两组差异无显著性，两组均无术中、术后并发症，随访6-12个月，随访率100％，均无复发。结论电视胸腔镜手术治疗术后乳糜胸疗效确切，具有创伤小、出血少、疼痛轻、术后切口愈合快和住院时间短等优点．为治疗术后乳糜胸的首选方法。

Retrospective contrast analysis of Video-assisted thoracoscopic surgery and Thoracotomy in treating postoperative chylothorax

Objective To evaluate the clinical impacts of video-assisted thoracoscopic surgery in treating postoperative chylothorax. Methods] Retrospective constract analysis of the clinical data of 11 patients who developed postoperative chylothorax. All of them underwent ligation of thoracic duct, 6 patients thoracotomy (thoracotomy group), 5 patients VATS (VATS group). Results] All of the patients underwent ligation of thoracic duct smoothly. The operative time was significantly longer for VATS group than for the thoracotomy group (P<0.05); the blood loss during operation was significantly less for VATS group than for the thoracotomy group (P<0.05); the time for incisional heal and the duration of hospitalization after operation were significantly shorter for VATS group than for the thoracotomy group (P<0.05); postoperative ache grade and the dose of intensive anodyne(morphine) used were significantly less for VATS group than for the thoracotomy group (P<0.05). There were no significant difference for the two groups at the duration and the volume of postoperative drainage and at the time of blood RT regain normal (P>0.05). There were no complications for the two groups during or after operation. There were no recurrence of chylothorax during Follow-up (range, 6 to12 months), and the rate of follow-up was 100%. Conclusions] VATS is an effective tool in the management of postoperative chylothorax. Its minimal invasion, less blood loss, less pain, rapid incisional healing and short length of stay suggest it is a preferred treatment of postoperative thylothorax.