【摘要】 本院1975—1985年间共施行食管癌切除手术846例,发生乳糜胸17例,发生率为2.01％。乳糜胸发生于左侧7例,右侧6例,双侧4例。16例于术后3天内发生,仅1例于术后7天发生。本组17例均先行保守治疗,8例中转手术,保守治疗死亡1例,中转手术后死亡1例。作者认为在主动脉弓上下这一区域分离食管或肿瘤时,对所分离切断的组织,必须不厌其烦地一一结扎,一旦疑有损伤胸导管,应直视下将胸导管低位双重缝扎,是防止发生乳糜胸的重要措施。保守治疗有一定的试探性,对部分病例,长期保守治疗,将贻误病情。乳糜液引流日量多于500ml者应及时中转手术,是提高治愈率的关键。本组手术8例9次,全部由右胸入路,有简单快捷、效果确实的特点。本文并介绍了这一手术方法和注意事项。更多还原

【Abstract】 Chylothorax occurred postoperatively in 17 cases among 846 patients inwhom the operation of esophageal carcinoma had been performed during 1975 to 1985. The morbility rate of chyloihorax was 2.01%. Among these 17 patients, 9 cases had tumors located at neck or upper thoracic esophagus, 7 at the middle third of esophagus and 1 at the lower third. Thirteen patients had tumor length over 5em. The tumors were all found to be closely adhered to the adjacent tissues. After excision of the tumors in all, except one, the esophago gastrostomies were performed at the neck region or above the arch of aorta. Chylothorax developped postoperatively within 3 days in 16 cases, only in one developped in the seventh day. After conservative therapy the chylous fistula in 8 cases failed to close and had to be treated with thoractomy. Two cases died of this complication. The authors pointed out that when isolation of the esophagus was done near to the arch of aorta, it was very important to ligate carefully all the tissues before resection. Once the thoracic duct was suspected to be injuried, it should be identified and ligated just aboud the diaphram. When the volume of chyle drained was more than 500ml daily, thoractomy is indicated since such patients would be deteriorated by conservative measures.The operations for this complication in our series were all performed with right intrathor-acic route. Results turned out to be satisfactory. The details of the operative technique were described.更多还原