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目的 探讨食管癌术后乳糜胸的原因及治疗方法。方法 分析 8例食管癌术后发生乳糜胸者的手术过程及术后引流量等相关指标。结果 本组 8例中 7例行主动脉弓上吻合 ,1例主动脉弓下吻合。术后病理均为鳞状细胞癌 ;其中T11例 ,T2 2例 ,T3 5例 ;N13例 ,N0 5例 ,M0 8例。术后引流量 2 4 1～ 16 4 1ml/d ,平均 5 82ml/d ,白蛋白总用量 0～ 5 2 0 g ,血浆总用量 4 0 0～ 10 0 0 0ml;5例行二次开胸胸导管结扎术治疗 ,两次手术间隔时间 12～34d。 3例保守治疗 ,胸腔注射重组人血白介素Ⅱ。全部病例均治愈。结论 肿瘤外侵处、主动脉弓后和弓上部位胸导管易受损伤 ,此为产生乳糜胸的主要原因 ,手术部位的良好显露在一定程度上可避免胸导管损伤。胸腔引流量平均在 30 0ml/d以上 ,保守治疗 1周无好转者 ,应考虑手术治疗
Objective To investigate the causes and treatment of postoperative chylothorax in esophageal cancer. Methods 8 cases of esophageal cancer patients with chylothorax after surgery and drainage and other related indicators. Results The group of 8 patients in 7 cases of aortic arch anastomosis, 1 case of aortic arch anastomosis. Postoperative pathology was squamous cell carcinoma; of which T11 cases, T2 2 cases, T3 5 cases; N13 cases, N0 5 cases, M0 8 cases. Postoperative drainage volume of 214-1161 ml / d, an average of 5 82ml / d, the total amount of albumin 0 ~ 520 g, the total amount of plasma 400 ~ 10 000 ml; 5 cases of secondary thoracotomy Thoracic duct ligation treatment, two surgical interval of 12 ~ 34d. 3 cases of conservative treatment, intrapleural injection of recombinant human interleukin Ⅱ. All cases were cured. Conclusion Thoracic duct is easily damaged by extravasation of the tumor, aortic arch and posterior arch of the thoracic duct. This is the main reason for the occurrence of chylothorax. The good exposure of the surgical site can avoid the injury of the thoracic duct. Thoracic drainage average more than 30 0ml / d, conservative treatment for 1 week without improvement, surgery should be considered