肺癌根治术后乳糜胸的治疗
摘要
目的：该项研究旨在观察、评估肺癌术后乳糜胸的发生规律和治疗效果。
方法：通过对本科室自2010年1月起至2011年3月因肺部肿瘤行肺癌根治术的病例共607例行回顾性调查研究。统计术后乳糜胸发生率及治疗效果。比较开胸组与腔镜组术后乳糜胸的不同发生率。
结果：肺癌根治术607例中8例发生术后乳糜胸,发生率1.32%。其中开胸组476例,乳糜胸4例,发生率0.84%。腔镜组131例,乳糜胸4例,发生率3.05%。胸腔镜手术并发乳糜胸可能性大于常规开胸手术(P<0.05)。两组病例在性别,年龄,病理类型方面比较无显著性差异(P>0.05)。8例乳糜胸患者中6例行保守治疗,1例行胸膜固定术,1例二次手术行胸导管结扎术。所有病例均成功治愈,无死亡病例。
结论：本组肺癌根治术后乳糜胸发生率为1.32%。患者经过保守治疗可以治愈,预后良好。需要行二次手术的患者仅12.5%。
Objective To investigate the morbidity of chylothorax after radical resection of pulmonary cancer and to evaluate its effectiveness of the treatments.
Method This study was based on 607 patients with resection of lung cancer in our hospital from January,2010 to March,2011.8 patients had postoperative complication of chylothorax,for which retrospective study was performed.
Results There are 8 chylothorax cases in 607 patients who underwent radical resection of lung cancer with the morbidity rate of 1.32%. Among them thoracotomy was used as the approach in 476 cases. The morbidity rate of the chylothorax was 0.84%(4/476). Thoracoscopy surgery was performed on 131 cases, the morbidity rate of the chylothorax is 3.05%(4/313). There is no significant difference in gender, age and the pathological aspect between two groups (P> 0.05). In these 8 patients of chylothorax,6 received conservative therapy,1 of them received pleurodesis,1 of them received ligation of thoracic duct in secondary operation. No postoperative mortality and morbidity were occurred for those patients.
Conclusion In this retrospective study the morbidity of chylothorax is 1.32% in radical resection of lung cancer. Most of the patients were able to be cured by the conservative therapy with a satisfactory prognosis. Only 0.16 per cent patients need secondary surgical intervention.
方法：通过对本科室自2010年1月起至2011年3月因肺部肿瘤行肺癌根治术的病例共607例行回顾性调查研究。统计术后乳糜胸发生率及治疗效果。比较开胸组与腔镜组术后乳糜胸的不同发生率。
结果：肺癌根治术607例中8例发生术后乳糜胸,发生率1.32%。其中开胸组476例,乳糜胸4例,发生率0.84%。腔镜组131例,乳糜胸4例,发生率3.05%。胸腔镜手术并发乳糜胸可能性大于常规开胸手术(P<0.05)。两组病例在性别,年龄,病理类型方面比较无显著性差异(P>0.05)。8例乳糜胸患者中6例行保守治疗,1例行胸膜固定术,1例二次手术行胸导管结扎术。所有病例均成功治愈,无死亡病例。
结论：本组肺癌根治术后乳糜胸发生率为1.32%。患者经过保守治疗可以治愈,预后良好。需要行二次手术的患者仅12.5%。
Objective To investigate the morbidity of chylothorax after radical resection of pulmonary cancer and to evaluate its effectiveness of the treatments.
Method This study was based on 607 patients with resection of lung cancer in our hospital from January,2010 to March,2011.8 patients had postoperative complication of chylothorax,for which retrospective study was performed.
Results There are 8 chylothorax cases in 607 patients who underwent radical resection of lung cancer with the morbidity rate of 1.32%. Among them thoracotomy was used as the approach in 476 cases. The morbidity rate of the chylothorax was 0.84%(4/476). Thoracoscopy surgery was performed on 131 cases, the morbidity rate of the chylothorax is 3.05%(4/313). There is no significant difference in gender, age and the pathological aspect between two groups (P> 0.05). In these 8 patients of chylothorax,6 received conservative therapy,1 of them received pleurodesis,1 of them received ligation of thoracic duct in secondary operation. No postoperative mortality and morbidity were occurred for those patients.
Conclusion In this retrospective study the morbidity of chylothorax is 1.32% in radical resection of lung cancer. Most of the patients were able to be cured by the conservative therapy with a satisfactory prognosis. Only 0.16 per cent patients need secondary surgical intervention.
引文
[1]Haniuda M,nishimura H,Kobayashi O,et al.Management of chylothorax after pulmonary resection. J Am Coll Surg,1995,180(5):537-540.
[2]Thompson KJ, Kernstine KH, Grannis FW Jr, et al. Case5-2007 postoperative complications after pneumonectomy:clinical conference.Ann Thorac Surg, 2008,85(1):334-336.
[3]Guo Weigang,Ge Di,Wang Qun.The comparision of chylothorax after pulmonary resection for lung cancer by different methods of lymph node dissection.Chinese Journal of Clinical Medicine,2009,16(1):362-364.
[4]赵峻,张德超,汪良骏,等.肺癌与食管癌术后乳糜胸的比较.中华外科杂志,2003,41：47-49.
[5]刘正津,姜宗来,殷玉芹.胸心外科临床解剖学.山东科学技术出版社,2000：5-11.
[6]李捷,孙玉鹗.肺切除术后乳糜胸的诊断和治疗.中华外科杂志,2003,41：713.
[7]潘文标,曹子昂,顾旭东,等.胸外科术后乳糜胸的诊断和治疗.现代医学,2010,Oct；38(5)：550-552.
[8]郭卫刚,葛棣,王群.肺癌淋巴结清扫不同术式对并发乳糜胸的影响比较.中国临床医学,2009,16(3)：362-364.
[9]王长利,姜宏景,刘朝永,等.肺癌术后乳糜胸的治疗对策.中国肿瘤临床,2004,31(5)：885-887.
[10]郑中锋,臧其威,等.肺癌术后并发乳糜胸42例临床分析.中国医师进修杂志,2007,30(9B)：52-53.
[11]Cardillo G,Facciolo F,Carbone L,et al.Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions.Eur J Cardiothorac Surg,2002,21(2):302-305.
[12]Liu W,Liu DP,Li B,et al.The treatment for postoperative chylothorax of esophageal cancer by intrathoracic injection of talc suspension.Mondern Oncology,2010,18 (9):1762-1765.
[13]Robert J,Mark S,Claude D,et al.Postoperative chylothorax.Thorac Cardiovasc Surg,1996,112(5):1361.
[14]Nishiyama N.Nakatani S,Iwasa R,et al.Direct approach to the site of injury of thoracic duct in treatment of chylothorax after pulmonary resection.Kyobu Geka,1997,50(11):971-973.
[15]Jackson TA,Mehran RJ,Thakur D,et al.treatment of chylothorax robotic thoracic duct ligation.Cardiothrac Vasc Anesth,2007,21(5):743-751.
[16]ThalkurB,Zhang CS,Cao FM.Use of greater omentun in thoracic oncosurgery. Kathmandu Univ Med,20075(1):129-132.
[17]Wan L,Wang JJ,Zhao F,et al.Diagnosis and management of chylothorax after resection of lung caner.Chin Lung Cancer,2009,12(8):905-906.
[1]Demos NJ,Kozel J,Scerbo JE. Somatostatin in the treatment of chylothorax.Chest,2001,119(3):964-966.
[2]王宇,张维军,刘宏旭.肺癌术后乳糜胸的治疗及原因分析.中国现代医药 杂志,Dec 2009,11,No.12：68-69.
[3]牛忠山,倪鹰,王志刚.肺术后乳糜胸的治疗体会.江西医药,2009,44,No.8：762-763.
[4]Sassoon CS,Light RW. Chylothorax and pseudochylothorax. Clin Chest Med, 1985,6:163-71.
[5]Ramos W,Faintuch J. Nutritional management of thoracic duct fistulas.A comparative study of parenteral versus enteral nutrition. J Parenter Enteral Nutr.1986,10(5):519-21.
[6]Chen J,Lin RK,Hassanein T. Use of orlistat(xenical) to treat chylous. J Clin Gastroenterol,2005,39(9):831-833.
[7]柳彦涛,侯亚利.乳糜胸的治疗进展.国际外科学杂志,2009,36(1)：57-60.
[8]Kalomenidis I. Octreotide and chylothorax.Curr Opin Pulm Med, 2006,12(4):264-267.
[9]Cannizzaro V,Frey B,Bernet-nuettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur J Cardiothorac Surg,200630(1):49-53.
[10]Roehr CC,Jung A,Proquitt H,et al. Somatostatin or octreotid as treatment options for chylothorax in young children:a systematic review.Intensive Care Menicine,2006.32(5):650-657.
[11]Buettiker V,Hug B,Burger R,et al. Somatostatin:A new therapeutic option for the treatment of chylothorax. Intensive Care Medicine,2001,27(6):1083-1086.
[12]Stajich GV,Ashworth L.Octreotide. Neonatal Netw,2006,25(5):365-369.
[13]Guillem P,Papachristos I,Peillon C,et al. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery.Interact Cardiovasc Thorac Surg,2004,3(1):156-160.
[14]Guillem P,Billeret V,Houcke ML,et al. Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine.Dis Esophagus, 1999,12(2):155-156.
[15]Murthy SC,Okereke I,Mason DP,et al. A simple solution for complicated pleural effusions.J Thorac Oncol,2006,1(7):697-700.
[16]Murphy MC,Newman BM,Rodgers BM. Pleuroperitoneal shunts in the management of persistent chylothorax.Ann Thorac Surg,1989.48(2):195-200.
[17]Engum SA,Rescorla FJ,West KW,et al. The use of pleuroperitoneal shunts in the management of persistent chylothorax in infants.J Pediatr Surg. 1999,34(2):286-290.
[18]Glazer M,Berkman N,Lafair JS,et al. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.Chest,2000,117(5):1404-1409.
[19]Cardillo G,Facciolo F,Carbone L,et al. Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions.Eur J Cardiothorac Surg,2002,21 (2):302-305.
[20]Maskell NA,Lee YC,Gleeson FV,et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size.Am J Respir Crit Care Med,2004,170(4):37-382.
[21]Thompson KJ,Kernstine KH,Grannis FW,et al. Treatment of chylothorax by robotic thoracic duct ligation. Ann Thorac Surg,2008,85(1):334-336.
[22]Cope C. Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med,2004,10(4):311-314.
[2]Thompson KJ, Kernstine KH, Grannis FW Jr, et al. Case5-2007 postoperative complications after pneumonectomy:clinical conference.Ann Thorac Surg, 2008,85(1):334-336.
[3]Guo Weigang,Ge Di,Wang Qun.The comparision of chylothorax after pulmonary resection for lung cancer by different methods of lymph node dissection.Chinese Journal of Clinical Medicine,2009,16(1):362-364.
[4]赵峻,张德超,汪良骏,等.肺癌与食管癌术后乳糜胸的比较.中华外科杂志,2003,41：47-49.
[5]刘正津,姜宗来,殷玉芹.胸心外科临床解剖学.山东科学技术出版社,2000：5-11.
[6]李捷,孙玉鹗.肺切除术后乳糜胸的诊断和治疗.中华外科杂志,2003,41：713.
[7]潘文标,曹子昂,顾旭东,等.胸外科术后乳糜胸的诊断和治疗.现代医学,2010,Oct；38(5)：550-552.
[8]郭卫刚,葛棣,王群.肺癌淋巴结清扫不同术式对并发乳糜胸的影响比较.中国临床医学,2009,16(3)：362-364.
[9]王长利,姜宏景,刘朝永,等.肺癌术后乳糜胸的治疗对策.中国肿瘤临床,2004,31(5)：885-887.
[10]郑中锋,臧其威,等.肺癌术后并发乳糜胸42例临床分析.中国医师进修杂志,2007,30(9B)：52-53.
[11]Cardillo G,Facciolo F,Carbone L,et al.Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions.Eur J Cardiothorac Surg,2002,21(2):302-305.
[12]Liu W,Liu DP,Li B,et al.The treatment for postoperative chylothorax of esophageal cancer by intrathoracic injection of talc suspension.Mondern Oncology,2010,18 (9):1762-1765.
[13]Robert J,Mark S,Claude D,et al.Postoperative chylothorax.Thorac Cardiovasc Surg,1996,112(5):1361.
[14]Nishiyama N.Nakatani S,Iwasa R,et al.Direct approach to the site of injury of thoracic duct in treatment of chylothorax after pulmonary resection.Kyobu Geka,1997,50(11):971-973.
[15]Jackson TA,Mehran RJ,Thakur D,et al.treatment of chylothorax robotic thoracic duct ligation.Cardiothrac Vasc Anesth,2007,21(5):743-751.
[16]ThalkurB,Zhang CS,Cao FM.Use of greater omentun in thoracic oncosurgery. Kathmandu Univ Med,20075(1):129-132.
[17]Wan L,Wang JJ,Zhao F,et al.Diagnosis and management of chylothorax after resection of lung caner.Chin Lung Cancer,2009,12(8):905-906.
[1]Demos NJ,Kozel J,Scerbo JE. Somatostatin in the treatment of chylothorax.Chest,2001,119(3):964-966.
[2]王宇,张维军,刘宏旭.肺癌术后乳糜胸的治疗及原因分析.中国现代医药 杂志,Dec 2009,11,No.12：68-69.
[3]牛忠山,倪鹰,王志刚.肺术后乳糜胸的治疗体会.江西医药,2009,44,No.8：762-763.
[4]Sassoon CS,Light RW. Chylothorax and pseudochylothorax. Clin Chest Med, 1985,6:163-71.
[5]Ramos W,Faintuch J. Nutritional management of thoracic duct fistulas.A comparative study of parenteral versus enteral nutrition. J Parenter Enteral Nutr.1986,10(5):519-21.
[6]Chen J,Lin RK,Hassanein T. Use of orlistat(xenical) to treat chylous. J Clin Gastroenterol,2005,39(9):831-833.
[7]柳彦涛,侯亚利.乳糜胸的治疗进展.国际外科学杂志,2009,36(1)：57-60.
[8]Kalomenidis I. Octreotide and chylothorax.Curr Opin Pulm Med, 2006,12(4):264-267.
[9]Cannizzaro V,Frey B,Bernet-nuettiker V. The role of somatostatin in the treatment of persistent chylothorax in children. Eur J Cardiothorac Surg,200630(1):49-53.
[10]Roehr CC,Jung A,Proquitt H,et al. Somatostatin or octreotid as treatment options for chylothorax in young children:a systematic review.Intensive Care Menicine,2006.32(5):650-657.
[11]Buettiker V,Hug B,Burger R,et al. Somatostatin:A new therapeutic option for the treatment of chylothorax. Intensive Care Medicine,2001,27(6):1083-1086.
[12]Stajich GV,Ashworth L.Octreotide. Neonatal Netw,2006,25(5):365-369.
[13]Guillem P,Papachristos I,Peillon C,et al. Etilefrine use in the management of post-operative chyle leaks in thoracic surgery.Interact Cardiovasc Thorac Surg,2004,3(1):156-160.
[14]Guillem P,Billeret V,Houcke ML,et al. Successful management of post-esophagectomy chylothorax/chyloperitoneum by etilefrine.Dis Esophagus, 1999,12(2):155-156.
[15]Murthy SC,Okereke I,Mason DP,et al. A simple solution for complicated pleural effusions.J Thorac Oncol,2006,1(7):697-700.
[16]Murphy MC,Newman BM,Rodgers BM. Pleuroperitoneal shunts in the management of persistent chylothorax.Ann Thorac Surg,1989.48(2):195-200.
[17]Engum SA,Rescorla FJ,West KW,et al. The use of pleuroperitoneal shunts in the management of persistent chylothorax in infants.J Pediatr Surg. 1999,34(2):286-290.
[18]Glazer M,Berkman N,Lafair JS,et al. Successful talc slurry pleurodesis in patients with nonmalignant pleural effusion.Chest,2000,117(5):1404-1409.
[19]Cardillo G,Facciolo F,Carbone L,et al. Long-term follow-up of video-assisted talc pleurodesis in malignant recurrent pleural effusions.Eur J Cardiothorac Surg,2002,21 (2):302-305.
[20]Maskell NA,Lee YC,Gleeson FV,et al. Randomized trials describing lung inflammation after pleurodesis with talc of varying particle size.Am J Respir Crit Care Med,2004,170(4):37-382.
[21]Thompson KJ,Kernstine KH,Grannis FW,et al. Treatment of chylothorax by robotic thoracic duct ligation. Ann Thorac Surg,2008,85(1):334-336.
[22]Cope C. Management of chylothorax via percutaneous embolization. Curr Opin Pulm Med,2004,10(4):311-314.