摘要
目的分析电视胸腔镜辅助下(video-assisted thoracoscopic surgery,VATS)肺癌根治术后乳糜胸的危险因素、治疗方法及临床效果。方法连续性收集四川大学华西医院胸外科2012年1月至2020年1月期间诊断为乳糜胸400例患者的临床资料。根据纳入、排除标准,最终纳入VATS肺癌根治术后乳糜胸患者37例,其中男20例、女17例,平均年龄(55.55±10.49)岁。乳糜胸诊断主要通过甘油三酯水平(高于110 mg/d L)或苏丹三染色试验,其治疗手段包括手术治疗与非手术治疗;分析VATS肺癌根治术后乳糜胸总体发生率、高危因素、治疗方法。根据其治疗方法,分为手术治疗组、非手术治疗组,回顾性分析两组患者的引流量、住院时间等数据。结果纳入患者占我院同期VATS肺癌手术患者0.3%(37/12515)。右肺手术患者术后乳糜胸发生率(0.2%,29/12515)明显高于左肺手术患者(0.1%,8/12515)。37例肺癌术后乳糜胸患者中,32例患者为非手术治疗组患者(86.5%,32/37),比例显著高于手术治疗组(13.5%,5/37,P=0.000)。手术治疗组平均每日引流量比非手术治疗组高777 m L[95%CI(588.58,965.55)],差异具有统计学意义(P<0.001);手术治疗组总引流量高于非手术治疗组,但差异无统计学意义[(8609.2±4680.3)m L vs.(4911.2±3925.5)m L,P=0.055]。手术治疗组术后住院时间及总住院时间均短于非手术治疗组,但差异无统计学意义(P=0.162,P=0.118)。手术治疗组引流管留置时间短于非手术治疗组,但差异无统计学意义[(8.2±2.7)d vs.(12.3±6.8)d,P=0.204]。结论VATS肺癌根治术后乳糜胸治疗仍以非手术治疗为主。VATS辅助下肺癌根治术后乳糜胸术后72 h引流量过大时,建议尽早开始手术治疗。
Objective To review and analyze the treatment of chylothorax after video-assisted thoracoscopic lung cancer surgery and to discuss the best clinical treatment methods and effects.Methods A total of 400 patients diagnosed with chylothorax at the Department of Thoracic Surgery,West China Hospital,Sichuan University from January 2012 to January 2020 were continuously collected.According to the inclusion and exclusion criteria,37 patients were finally included.There were 20 males and 17 females with an average age of 55.55±10.49 years.Chylothorax was diagnosed primarily by triglyceride levels(above 110 mg/d L)or the Sudan triple stain test.Treatment included surgical and nonsurgical treatment.The overall incidence,high risk factors and treatment methods of chylothorax after radical thoracoscopic surgery for lung cancer were analyzed.According to the treatment methods,the patients were divided into a surgical treatment group and a non-surgical treatment group.The average daily drainage volume and average hospital stay of the patients between the two groups were analyzed.Results Included patients accounted for 0.3%(37/12515)of lung cancer thoracoscopic surgery in our hospital during the same period.The incidence of postoperative chylothorax in patients with right lung surgery(0.2%,29/12515)was higher than that of patients with left lung surgery(0.1%,8/12515).Of 37 patients with chylothorax after lung cancer surgery,32 patients were in the non-surgical treatment group(86.5%,32/37),and the rate was higher compared with the surgical treatment group(13.5%,5/37,P=0.000).The average daily drainage in the surgical treatment group was 777 m L more than that in the non-surgical treatment group(95%CI 588.58 to965.55,P<0.001).The total drainage volume of the surgical treatment group was more than that of the non-surgical treatment group(8609.2±4680.3 m L vs.4911.2±3925.5 m L,P=0.055).The postoperative hospital stay and total hospital stay in the surgical treatment group were shorter than those in the non-surgical treatment gro
作者
董映显
赖玉田
周坤
车国卫
DONG Yingxian;LAI Yutian;ZHOU Kun;CHE Guowei(Department of Thoracic Surgery,West China Hospital,Sichuan University,Chengdu,610041,P.R.China)
出处
《中国胸心血管外科临床杂志》
CSCD
北大核心
2022年第1期62-67,共6页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
基金
四川省科技厅重点项目(2020YFS0252)
四川省干部保健科研课题项目(HZ2019-103)。
关键词
乳糜胸
肺癌
治疗方法
手术
Chylothorax
lung cancer
treatment method
surgery
