食管癌术后乳糜胸的相关危险因素及治疗措施

目的:探讨食管癌术后发生乳糜胸的相关危险因素及治疗措施对预后的影响.方法:回顾性分析2008年5月-2015年5月我院食管癌手术合并乳糜胸患者65例并随机抽取同期未发生乳糜胸的食管癌手术患者70例的临床资料.结果:术中不预防性结扎胸导管、肿瘤浸润纤维膜外、肿瘤位于中上段食管、左侧开胸入路、淋巴结转移个数大于5、单纯结扎胸导管、体重指数大于等于28、非胸腔镜手术均与乳糜胸的发生显著相关(P<0.05).开始肠内营养大于等于36小时、二次手术时间大于36小时、胸腔引流量小于1000ml/24小时和保守治疗均与乳糜胸后继相关并发症的发生显著相关(P<0.05).结论:食管癌手术需重视乳糜胸的相关危险因素及对乳糜胸的合理治疗.

Related risk factors and the treatment strategies of chylothorax in esophagectomy

Objective:To investigate the related risk factors of chylothorax post - esophagectomy and the affection of treatment strategies for prognosis. Methods:The clinical data of 65 patients with chylothorax post - esophagectomy and 70 patients without chylothorax post - esophagectomy from may 2008 to may 2015 were analyzed retrospectively. Results:The surgeon haven't ligated the thoracic duct preventively,the tumor has infiltrated outside the fiber mem-brane,left thoracotomy,the tumor located in the middle and upper esophagus,the lymph nodes were more than 5,body mass index (BMI)≥28,the surgeon just precisely ligated the thoracic duct and non thoracoscopic surgery were the independent risk factors for the occurrence of chylothorax(P < 0. 05). Start enteral nutrition in more than 36 hours af-ter surgery,the patients underwent second thoracotomy in more than 36 hours after surgery,the thoracic drainage≥1000ml/ 24h after surgery and conservative treatment were the independent risk factors for the occurrence of com-plications with chylothorax(P < 0. 05). Conclusion:We shoued pay more attention to the related risk factors and the right treatment strategies of chylothorax in esophagectomy.