Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital and Maulana Azad Medical College, Second floor, Academic Block, 1, Jawaharlal Nehru Marg, New Delhi 110002, India.
World J Surg. 2013 Jan;37(1):141-6. doi: 10.1007/s00268-012-1811-x.
Thoracic duct injury (TDI) is a potentially lethal complication of esophagectomy. There is no consensus regarding when and how to intervene in these injuries. Both thoracic and abdominal approaches have been used.
Esophagectomies performed for cancer of the esophagus (n = 104) from October 2003 to July 2011 were analyzed for TDI. Diagnosis, histological type, stage, and location of tumor, neoadjuvant therapy, trans-thoracic or trans-hiatal procedure performed, nature and amount of drain output, and levels of triglyceride in the effluent were analyzed. Management of these injuries and morbidity and mortality associated with the approach taken were reviewed.
We observed chylothorax in 9 patients. All nine patients had undergone trans-hiatal esophagectomy. All patients eventually required surgical intervention. Mass ligation of the thoracic duct was performed via the thoracic route in three patients and via the trans-abdominal approach in six others. Thoracic duct ligation was successful in all patients. One patient required a second laparotomy and repeat ligation of the duct. There were two postoperative deaths; both these patients had ligation by the thoracic route.
Trans-abdominal ligation of the thoracic duct in patients with chylothorax after esophagectomy is technically easy and safe. It may be preferred over the trans-thoracic approach, especially after an initial trans-hiatal esophagectomy.
胸导管损伤（TDI）是食管癌切除术的一种潜在致命并发症。对于这些损伤，何时以及如何进行干预尚无共识。已经使用了经胸和经腹两种方法。
对 2003 年 10 月至 2011 年 7 月期间因食管癌而行食管癌切除术的患者（n=104）进行了 TDI 分析。分析了诊断、组织学类型、分期和肿瘤位置、新辅助治疗、经胸或经食管裂孔手术、引流液的性质和量以及流出物中的甘油三酯水平。回顾了这些损伤的处理方法以及所采用方法的发病率和死亡率。
我们观察到 9 例乳糜胸。所有 9 例患者均接受了经食管裂孔切除术。所有患者最终均需手术干预。3 例患者经胸途径行胸导管大块结扎，6 例患者经腹途径行胸导管结扎。所有患者的胸导管结扎均成功。1 例患者需要再次剖腹手术并重复结扎导管。有 2 例术后死亡；这 2 例患者均经胸途径结扎。
在食管癌切除术后发生乳糜胸的患者中，经腹结扎胸导管在技术上是简单和安全的。与经胸途径相比，它可能是首选方法，尤其是在初次经食管裂孔手术后。
