Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of Surgical Gastroenterology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Langenbecks Arch Surg. 2021 Nov;406(7):2515-2520. doi: 10.1007/s00423-021-02300-y. Epub 2021 Aug 19.
Chyle leak is a rare but morbid complication of esophagectomy. We assessed the feasibility of visualization and prophylactic ligation of the opacified thoracic duct (TD) after administration of 50 ml of olive oil.
This prospective single center study considered all patients with carcinoma of the middle and lower thirds of the thoracic esophagus including the gastroesophageal junction (GEJ), managed from January 2018 to December 2019, for inclusion. All patients underwent McKeown minimally invasive esophagectomy. After anesthesia and endotracheal intubation, 50 ml of olive oil was administered through a nasogastric (NG) tube. During thoracoscopic esophageal mobilization, the opacified thoracic duct was identified and ligated using Weck Hem-o-lok clips immediately above the diaphragmatic hiatus. Postoperatively, the nature, volume, and triglyceride levels of the fluid from the chest drain were recorded.
Forty-three patients with carcinoma of the esophagus were assessed for inclusion and eventually, 33 were enrolled. The median age of the study population was 55 years, and there were 20 males. The tumor site was the lower esophagus in 24 (72.7%) patients. The most common histolopathological finding was squamous cell carcinoma (97%). The opacified thoracic duct could be identified and ligated in 31 (93.9%) patients. The median duration from the administration of olive oil to the ligation of the thoracic duct was 100 min. The median chest drain output and triglyceride levels on postoperative day (POD) one were 250 ml and 48 mg% respectively. No patient developed postoperative chylothorax.
Opacification and visualization of the thoracic duct during thoracoscopy can be aided by administering olive oil. Ligation of this opacified duct is feasible and safe.
乳糜漏是食管切除术后罕见但严重的并发症。我们评估了在给予 50 毫升橄榄油后，使胸导管（TD）显影并预防性结扎的可行性。
这项前瞻性单中心研究纳入了 2018 年 1 月至 2019 年 12 月期间所有接受中下胸段食管（包括胃食管交界处[GEJ]）癌治疗的患者。所有患者均接受 McKeown 微创食管切除术。麻醉和气管插管后，通过鼻胃管（NG）管给予 50 毫升橄榄油。在胸腔镜食管游离过程中，一旦发现胸导管显影，就在膈裂孔上方用 Weck Hem-o-lok 夹夹闭。术后记录胸腔引流管中液体的性质、量和甘油三酯水平。
对 43 例食管癌患者进行了纳入评估，最终有 33 例患者入组。研究人群的中位年龄为 55 岁，其中男性 20 例。肿瘤部位在下段食管的 24 例（72.7%）。最常见的组织病理学发现是鳞状细胞癌（97%）。31 例（93.9%）患者的胸导管可被识别并结扎。从给予橄榄油到结扎胸导管的中位时间为 100 分钟。术后第 1 天胸腔引流的中位引流量和甘油三酯水平分别为 250 毫升和 48mg%。没有患者发生术后乳糜胸。
在胸腔镜下给予橄榄油可以帮助显影和可视化胸导管。结扎这条显影的导管是可行且安全的。
