论文部分内容阅读
目的探讨达芬奇机器人肺癌根治术后并发乳糜胸患者的诊断及治疗方案。方法自2011年10月至2015年12月,沈阳军区总医院胸外科应用达芬奇机器人手术系统(DVSS)行肺癌根治术治疗肺癌患者219例,其中,术后并发乳糜胸5例(发生率2.28%),均给予保守治疗。治疗措施包括:(1)夹闭胸引管;(2)胸腔内注射红霉素0.25 g+利多卡因0.1 g+浓糖20 ml;(3)皮下注射奥曲肽+胸腔内注入金葡素。结果全部219例患者均顺利完成手术,无中转开胸。术后5例并发乳糜胸患者的病理类型分别为2例鳞癌、3例腺癌,病理分期分别为Ⅰa期3例、Ⅱa期1例、Ⅲa期1例,清除淋巴结数分别为18枚(0/18,N0)、8枚(1/8,N1)枚、9枚(4/9,N2)、24枚(0/24,N0)及42枚(0/42,N0),平均(20.20±13.86)枚。经保守治疗后,4例治愈(治愈率80.00%),1例死亡(死亡率20.00%)。结论 DVSS肺癌根治术后出现乳糜胸时,及时诊断并选择恰当治疗,可取得良好的治疗效果,减少死亡率;另外,应特别注意患者淋巴结清扫过程中的副损伤。
Objective To investigate the diagnosis and treatment of da Vinci robotic patients with chylothorax after radical operation of lung cancer. METHODS: From October 2011 to December 2015, 219 patients with lung cancer undergoing radical surgery for lung cancer underwent da Vinci robotic surgery (DVSS) were performed in the Department of Thoracic Surgery, Shenyang Military Region General Hospital. Among them, 5 cases were complicated with chylothorax 2.28%), were given conservative treatment. Treatment include: (1) Closure of the chest tube; (2) intrapleural injection of erythromycin 0.25 g + lidocaine 0.1 g + concentrated sugar 20 ml; (3) subcutaneous injection of octreotide + intrapleural injection of kainin. Results All 219 patients underwent successful surgery without thoracotomy. The pathological types of 5 patients with chylothorax after operation were 2 cases of squamous cell carcinoma and 3 cases of adenocarcinoma respectively. There were 3 cases of stage Ⅰa, 1 case of stage Ⅱ a, 1 case of stage Ⅲa, the number of clear lymph nodes was 18 (0/18, N0), 8 pieces (1/8, N1), 9 pieces (4/9, N2), 24 pieces (0/24, N0) and 42 pieces (0/42, N0) 20.20 ± 13.86) pieces. After conservative treatment, 4 cases were cured (cure rate 80.00%), 1 case died (mortality 20.00%). Conclusions When chylothorax is diagnosed after radical resection of lung cancer, timely diagnosis and proper treatment can achieve good therapeutic effect and reduce mortality rate. In addition, special attention should be paid to the secondary injury in patients with lymph node dissection.