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目的探讨预防性胸导管结扎对食管癌术后乳糜胸的发生率以及术后胸腔引流量的影响。方法采用前瞻性研究,连续纳入2014年1月至2015年1月在四川大学华西医院胸外科接受手术治疗的120例食管癌患者的临床资料,并随机分为结扎组和未结扎组。结扎组62例患者进行了预防性膈上低位结扎胸导管(男性49例,女性13例);未结扎组58例患者未预防性结扎胸导管(男性44例,女性14例)。住院期间观察有无乳糜胸的发生及记录胸腔引流量的情况,收集患者的胸腔引流液并分析,对结扎组和未结扎组两组之间乳糜胸的发生及胸腔引流量进行比较。结果结扎组和未结扎组两组患者的平均年龄、性别比例、食管癌肿块位置、TNM分期、淋巴结清扫枚数和手术方式差异均无统计学意义(P>0.05);两组患者的胸腔引流管拔管时间、住院天数、住院总费用差异均无统计学意义(P>0.05),乳糜胸、肺部感染、吻合口瘘及术后胸腔引流量差异均无统计学意义(P>0.05)。结论预防性结扎胸导管不能有效减少食管癌术后乳糜胸的发生及术后胸腔引流量。
Objective To investigate the effect of prophylactic thoracic duct ligation on the incidence of postoperative chylothorax and esophagectomy postoperative thoracic drainage. Methods A prospective study was conducted in 120 consecutive patients with esophageal cancer undergoing surgery in the Department of Thoracic Surgery, West China Hospital, Sichuan University from January 2014 to January 2015, and were randomly divided into ligation group and non-ligation group. Sixty-two patients in the ligation group underwent prophylactic diaphragmatic ligation of the thoracic duct (49 males and 13 females). Thirty-eight non-ligation patients underwent unchecked thoracotomy (44 males and 14 females). During hospitalization, the occurrence of chylothorax and the recording of chest drainage were recorded. Thoracic drainage fluid was collected and analyzed. The incidence of chylothorax and drainage of thoracic cavity between the two groups were compared. Results There were no significant differences in mean age, gender, esophageal mass location, TNM stage, number of lymph node dissection and surgical procedure between the two groups (P> 0.05). There was no significant difference between the two groups There was no significant difference in extubation time, hospitalization days and total cost of hospitalization (P> 0.05). There was no significant difference in chylothorax, pulmonary infection, anastomotic leakage and postoperative thoracic drainage (P> 0.05). Conclusion Preventive ligation of thoracic duct can not effectively reduce the occurrence of postoperative chylothorax and postoperative thoracic drainage.