Nakanishi Kozo
Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Wako, Japan.
Kyobu Geka. 2021 Sep;74(10):862-866.
Chylothorax is not a rare complication of lung surgery. Diagnosis is easy in most cases, but treatment is sometimes difficult. Dietary restriction is effective in reducing the chyle but does not always cease the lymph and chyle. Two surgical procedures for postoperative chylothorax are well known:direct closure of the ruptured lymph vessel and ligation of the thoracic duct. Direct closure often fails. It is difficult to detect lymphatic leakage pre- and peri-reoperation. Early reoperation decisions are important for successful direct closure. Thoracic duct ligation is ordinarily performed using the right thoracoscopic approach because the thoracic duct runs in front of the vertebrae along the azygos vein near the diaphragm in the right pleural cavity. The effect of the ligation should be shown immediately. Unfortunately, even if the thoracic duct is confirmed to have been ligated, it sometimes fails to cease the chyle pleural effusion. This may be due to the existence or formation of lymphatic bypass routes.
乳糜胸是肺手术并不罕见的并发症。多数情况下诊断容易，但治疗有时困难。饮食限制对减少乳糜有效，但并不总能停止淋巴液和乳糜的产生。术后乳糜胸的两种外科手术方法广为人知：直接闭合破裂的淋巴管和结扎胸导管。直接闭合常常失败。术前及围手术期很难检测到淋巴漏。早期再次手术的决策对于成功进行直接闭合很重要。胸导管结扎通常采用右胸镜入路，因为胸导管在右胸腔内沿奇静脉走行于椎体前方，靠近膈肌。结扎效果应立即显现。不幸的是，即使确认胸导管已被结扎，有时仍无法停止乳糜性胸腔积液。这可能是由于淋巴旁路的存在或形成。
