Cerfolio Robert James
Section of General Thoracic Surgery, University of Alabama at Birmingham, AL 35294, USA.
Thorac Surg Clin. 2006 Feb;16(1):49-52. doi: 10.1016/j.thorsurg.2006.01.009.
In conclusion, chylothorax after esophagectomy is a devastating complication with high mortality rates if not corrected. A heightened awareness of this complication with early diagnosis and aggressive reoperation leads to excellent outcome. Reoperation is not indicated only when medical therapy significantly slows the daily loss of chyle and there are no metabolic consequences. The early decision to reoperate avoids the high morbidity of a persistently unchecked chylothorax. Reoperation should be based on the approach initially used for the esophagectomy, the location of the leak, and the side that has the chylothorax. The conduit should be handled carefully at the time of reoperation, the leak identified, the duct or the leaking nodal basin clipped and glued, and a pleurodesis performed. Following these principles minimizes the morbidity of a serious postoperative complication.
总之，食管切除术后乳糜胸是一种严重的并发症，若不纠正，死亡率很高。提高对这种并发症的认识，早期诊断并积极再次手术可带来良好的结果。只有当内科治疗显著减缓乳糜的每日丢失且无代谢后果时，才不建议再次手术。早期决定再次手术可避免乳糜胸持续未得到控制而导致的高发病率。再次手术应基于最初用于食管切除术的方法、漏口的位置以及发生乳糜胸的一侧。再次手术时应小心处理管道，确定漏口，夹闭并粘贴漏出的导管或淋巴结区域，并进行胸膜固定术。遵循这些原则可将严重术后并发症的发病率降至最低。
