增强胸部CT三维重建联合术前给予橄榄油对术后乳糜胸发生率的影响：一项回顾性研究
Impact of enhanced chest CT with three-dimensional reconstruction combined with preoperative olive oil administration on the incidence of postoperative chylothorax: a retrospective study.
作者信息
Luo Xindong, Lu Di, Wang Ziqiang, Wang Jingyi, Dong Ruozhu, Wang Yaping, Cao Wei, Jin Dacheng, Lin Zhaohao, Li Haochi, Du Pengcheng, Gou Yunjiu, Dong Pengcheng, Yang Yayuan
机构信息
The First Clinical Medical College, Gansu University of Chinese Medicine, Lanzhou, China.
Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, China.
出版信息
J Cardiothorac Surg. 2025 Feb 1;20(1):112. doi: 10.1186/s13019-024-03319-0.
BACKGROUND
Chylothorax is a rare but potentially life-threatening complication after esophageal cancer resection. This study aims to investigate the impact of a strategy combining preoperative three-dimensional (3D) reconstruction of contrast-enhanced chest CT with olive oil ingestion on the incidence of chylothorax following esophageal cancer resection.
METHODS
We retrospectively analyzed the clinical data of 357 patients who underwent esophageal cancer resection in the Department of Thoracic Surgery at Gansu Provincial People's Hospital from January 2019 to June 2024. Among them, 179 patients who underwent preoperative 3D reconstruction of contrast-enhanced chest CT combined with oral olive oil administration were assigned to the 3D reconstruction group, while 158 patients who did not receive these interventions served as the control group. The primary outcome measures included the incidence of chylous leakage and related perioperative outcomes.
RESULTS
All patients in both groups underwent surgeries successfully without any perioperative deaths. Compared to the control group, the 3D reconstruction group exhibited a significant decrease in the incidence of postoperative chylothorax (0% versus 8.2%, P < 0.001). The visualization rate of the thoracic duct during surgery was higher in the 3D reconstruction group compared to the control group (93.85% vs. 48.73%). Furthermore, patients in the 3D reconstruction group had less intraoperative bleeding (P = 0.003), shorter postoperative hospital stays (P = 0.003), and reduced chest drainage in the first three postoperative days (P < 0.001).
CONCLUSION
This study reveals that preoperative three-dimensional reconstruction of chest using enhanced CT allows for the anticipation of thoracic duct anatomy. Additionally, the combination of preoperative oral olive oil administration significantly enhances the intraoperative visualization of the thoracic duct. This integrated strategy effectively reduces the incidence of postoperative chylothorax, demonstrating promising clinical application prospects.
背景
乳糜胸是食管癌切除术后一种罕见但可能危及生命的并发症。本研究旨在探讨术前胸部增强CT三维（3D）重建联合口服橄榄油的策略对食管癌切除术后乳糜胸发生率的影响。
方法
我们回顾性分析了2019年1月至2024年6月在甘肃省人民医院胸外科接受食管癌切除术的357例患者的临床资料。其中，179例接受术前胸部增强CT三维重建并口服橄榄油的患者被分配到3D重建组，而158例未接受这些干预措施的患者作为对照组。主要观察指标包括乳糜漏的发生率及相关围手术期结局。
结果
两组所有患者均成功完成手术，无围手术期死亡。与对照组相比，3D重建组术后乳糜胸的发生率显著降低（0%对8.2%，P < 0.001）。3D重建组术中胸导管的可视化率高于对照组（93.85%对48.73%）。此外，3D重建组患者术中出血更少（P = 0.003），术后住院时间更短（P = 0.003），术后前三天的胸腔引流量减少（P < 0.001）。
结论
本研究表明，术前使用增强CT对胸部进行三维重建可预判胸导管的解剖结构。此外，术前口服橄榄油显著提高了术中胸导管的可视化程度。这种综合策略有效降低了术后乳糜胸的发生率，显示出良好的临床应用前景。
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