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目的探讨经右胸入路胸腔镜下胸导管结扎在乳糜胸治疗中的作用及优势。方法回顾性分析南京军区南京总医院心胸外科2012~2014年采用胸腔镜手术治疗乳糜胸18例患者的临床资料,男15例、女3例,年龄56~79(66.56±6.43)岁。所有患者均采用右胸入路胸腔镜辅助下行胸导管结扎,术中若能找到明显破口,则在破口的两端用Ham-lock夹闭胸导管,若未能找到明确的胸导管破口,则在第8、第9胸椎附近用Ham-lock将胸导管及周围脂肪组织一起夹闭。结果全组1 8例患者均完成手术,无中转开胸,手术时间28~45(35.83±4.58)min,术后胸腔引流时间2~5(3.33±1.03)d,术后住院时间5~8(6.11±1.02)d。术后无感染、吻合口瘘等严重并发症,随访3个月无复发。结论经右胸入路胸腔镜辅助手术结扎胸导管治疗乳糜胸是一种安全、有效的治疗方法,因其微创、住院时间短、手术效果确切等优点,值得在临床上推广。
Objective To investigate the effect and advantages of thoracoscopic thoracoscopic thoracic duct ligation in the treatment of chylothorax by right thoracic approach. Methods The clinical data of 18 patients undergoing thoracoscopic surgery for chylothorax from 2012 to 2014 in Nanjing General Hospital of Nanjing Military Command from 2012 to 2014 were retrospectively analyzed. There were 15 males and 3 females, aged 56-79 years (66.56 ± 6.43) years. All patients underwent right thoracoscopic assisted thoracoscopy assisted thoracic duct ligation, intraoperative if you can find a clear break, the ends of the break with Ham-lock clip thoracic duct, if you can not find a clear thoracic duct break Mouth, then the chest thoracic duct and surrounding adipose tissue are clamped together with the Ham-lock near the eighth and the ninth thoracic spine. Results All the 18 patients underwent surgery without conversion to thoracotomy. The operative time ranged from 28 to 45 (35.83 ± 4.58) min, postoperative chest drainage time was 2 to 5 (3.33 ± 1.03) days, postoperative hospital stay was from 5 to 8 (6.11 ± 1.02) d. No postoperative infection, anastomotic leakage and other serious complications, followed up for 3 months without recurrence. Conclusion Thoracoscopic thoracoscopic thoracoscopic assisted thoracic catheterization in the treatment of chylothorax is a safe and effective treatment. Due to its advantages such as minimally invasive, short hospital stay and exact operative results, it is worth to be popularized clinically.