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目的 探讨食管癌手术后乳糜胸的诊断与治疗。方法 回顾性研究 196 2 - 2 0 0 2年食管癌切除术 2 6 78例 ,术后并发乳糜胸 39例。结果 保守治疗 :治愈 2 1例 ,死亡 1例 ,拒绝二次手术 1例。手术治疗 :治愈 15例 ,死亡 1例。结论 食管癌切除术后如果胸液量持续增多或减少后又增多 ,胸液量达到或超过 5 0 0ml/ 2 4h ,应高度怀疑乳糜胸可能 ,结合胸液苏丹Ⅲ染色、胆固醇和甘油三酯水平测定等实验室检查 ,可明确乳糜胸的诊断。治疗应从保守治疗入手 ,其中滑石粉可作为良好的胸膜粘着剂 ,具有疗效可靠、不良反应少等优点。若保守治疗效果不佳 ,则应进行积极的外科手术 ,行胸导管结扎术
Objective To investigate the diagnosis and treatment of chylothorax after esophageal cancer surgery. Methods A retrospective study was performed on 2678 cases of esophageal cancer resection from 1996 to 2002 and 39 cases of postoperative chylothorax. Conservative treatment results: 21 cases were cured, 1 died, 1 case refused secondary surgery. Surgical treatment: 15 cases were cured and 1 died. Conclusions If esophageal cancer continues to increase or decrease after esophageal resection, the volume of pleural effusion reaches or exceeds 500 ml / 2 4 h, the suspicion of chylothoractomy should be highly suspected. Combined with the stool Sudan Ⅲ staining, cholesterol and triglyceride Laboratory tests such as level determination can confirm the diagnosis of chylothorax. Treatment should start with conservative treatment, of which talc can be used as a good pleural adhesive, with reliable, less adverse reactions and so on. If the conservative treatment ineffective, should undergo a positive surgical operation, thoracic duct ligation