Nakamura Daisuke, Toishi Masayuki, Sakaizawa Takao, Koike Sachie, Nishimura Hideki
Department of Chest Surgery, Nagano Municipal Hospital, Nagano, Nagano, Japan.
Department of General Medicine, Matsushiro General Hospital, Nagano, Nagano, Japan.
J Surg Case Rep. 2021 Oct 31;2021(10):rjab490. doi: 10.1093/jscr/rjab490. eCollection 2021 Oct.
Postoperative chylothorax occurs relatively rarely after pulmonary resections, often caused intraoperatively by injury to the thoracic duct. We describe a case of postoperative chylothorax after lung cancer surgery with an aberrant thoracic duct course. A 66-year-old man showed abnormal findings on chest computed tomography (CT) during health screening and was suspected with primary lung cancer. Then, he underwent a right upper lobectomy with mediastinal lymph-node dissection. The histopathological findings confirmed lung adenocarcinoma. However, the patient developed a postoperative chylothorax and underwent revision surgery. An abnormally running thoracic duct, which was expected to flow into the right venous angle, was found at the cranial side of the right superior mediastinal dissection area and was clipped. Considering the many variations in the route of the thoracic duct, thoracic surgeons should remain alert for postoperative chylothorax when performing lung cancer surgery with mediastinal lymph-node dissection and prepare treatment strategies accordingly.
乳糜胸在肺切除术后相对少见,通常是由术中胸导管损伤引起的。我们描述了一例肺癌手术后出现乳糜胸的病例,该患者胸导管走行异常。一名66岁男性在健康筛查时胸部计算机断层扫描(CT)显示异常,怀疑患有原发性肺癌。随后,他接受了右上叶切除及纵隔淋巴结清扫术。组织病理学检查结果证实为肺腺癌。然而,患者术后出现了乳糜胸并接受了翻修手术。在右上纵隔清扫区域的头侧发现了一条走行异常、预计流入右静脉角的胸导管,并对其进行了夹闭。考虑到胸导管走行的多种变异,胸外科医生在进行肺癌手术并清扫纵隔淋巴结时应警惕术后乳糜胸的发生,并相应地制定治疗策略。