CAJ | 학술논문

目的探讨食管癌患者术前口服脂肪乳能否降低术后乳糜胸发生率.方法分析研究458例行胸腔镜手术治疗的食管癌患者,其中218例术前8h给予口服脂肪乳250 ml(实验组),对照组240例按常规术前准备.采用胸腔镜经右胸食管癌根治术(430例)或中转右侧三切口手术(28例),术中常规结扎胸导管.统计分析两组患者性别、年龄、病变部位、T分期、病理类型、手术方式、住院时间、乳糜胸发生率及术后其他并发症等临床资料.结果两组患者一般资料差异无统计学意义,实验组乳糜胸发生率低于对照组(0.92％ vs 5.42％,P＜ 0.01),实验组2例乳糜胸患者经保守治疗后痊愈;对照组1 3例乳糜胸中有5例保守治疗失败,再次行手术结扎胸导管,1例二次手术后肺感染呼吸衰竭死亡.其他并发症两组无明显差别(P＞0.05).结论食管癌患者术前口服脂肪乳可以使胸导管充盈,降低误伤胸导管可能,使术中乳糜漏更易于发现,降低了术后乳糜胸发生率.
목적 탐토식관암환자술전구복지방유능부강저술후유미흉발생솔.방법 분석연구458례행흉강경수술치료적식관암환자,기중218례술전8h급여구복지방유250 ml(실험조),대조조240례안상규술전준비.채용흉강경경우흉식관암근치술(430례)혹중전우측삼절구수술(28례),술중상규결찰흉도관.통계분석량조환자성별、년령、병변부위、T분기、병리류형、수술방식、주원시간、유미흉발생솔급술후기타병발증등림상자료.결과 량조환자일반자료차이무통계학의의,실험조유미흉발생솔저우대조조(0.92％ vs 5.42％,P＜ 0.01),실험조2례유미흉환자경보수치료후전유;대조조1 3례유미흉중유5례보수치료실패,재차행수술결찰흉도관,1례이차수술후폐감염호흡쇠갈사망.기타병발증량조무명현차별(P＞0.05).결론 식관암환자술전구복지방유가이사흉도관충영,강저오상흉도관가능,사술중유미루경역우발현,강저료술후유미흉발생솔.
Objective To explore whether preoperative oral administration of intralipid can decrease the rate of postoperative chylothorax in patients with esophageal cancer.Methods 458 patients with esophageal cancer undergoing esophagectomy by VATS (Video-Assisted Thoracoscopic Surgery) were analyzed and studied;among which,218 orally taking 250 ml intralipid 8 hours before the operation were set as an experimental group and the other 240 routinely prepared as a control group.The surgical procedure was McKeown operation by VATS or thoractomy if necessary.430 cases were failed VATS,and 28 cases were converted to open thoractomy.Thoracic duct ligation was performed for all the cases during the operation.The sex,age,location of the tumor,T stage,histologic types,surgical procedures,length of hospital stay,incidence of postoperative chylothorax,and other complications of both groups were calculated.Results There were no statistical differences in basic clinical features between these 2 groups.The incidence rate of postoperative chylothorax was lower in the experimental group than in the control group (0.92％ vs.5.42％,P＜0.01).2 cases of postoperative chylothorax in the experimental group were cured by conservative treatment;however,5 of the 13 cases of postoperative chylothorax in the control group were cured by conservative treatment and needed to be surgically treated,and 1 case died from lung infection and respiratory failure after the second surgery.There was no statistical difference in other postoperative complications between the 2 groups(P＞0.05).Conclusions Oral administration of intralipid before esophagectomy for patients with esophageal cancer can make the thoracic duct filled with chyle,minimize the risk of iatrogenic injury,easily find the chylothorax,and lower the incidence of postoperative chylothorax.