Alexiou C, Watson M, Beggs D, Salama F D, Morgan W E
Thoracic Surgery Unit, City Hospital, Nottingham, UK.
Eur J Cardiothorac Surg. 1998 Nov;14(5):460-6. doi: 10.1016/s1010-7940(98)00230-9.
To define the incidence, causes, management and impact of Chylothorax after oesophagogastrectomy for malignant disease in Nottingham Thoracic Surgery unit.
Retrospective analysis of 523 patients with cancer of the oesophagus or the gastro-oesophageal junction who underwent oesophageal resection between January 1987 and November 1997 in a single unit using similar techniques and uniform routine perioperative management.
Chylothorax occurred in 21 patients (4.0%). There were 12 males and 9 females with a mean age of 64.7 years (SD 7.5). Age, sex, tumour site, length, histological type, depth of wall penetration, nodal status and type of operative approach were not significant predisposing factors on univariate and multivariate analysis. Seventeen patients were treated conservatively (four deaths, 23.5%) and four surgically (one death, 25.0%), effective control of the chylous leak being achieved in all four cases. Eleven patients with a chylous drainage of up to 2.2 l/day, diminishing within 1 week of conservative treatment had an uneventful recovery. However, a chylous drainage of more than 2.5 l/day in the remaining ten patients was associated with increased morbidity, hospital stay, operative mortality and the need for surgical intervention. In comparison with the remaining patients (n = 502), those who developed chylothorax (n = 21) had more respiratory complications (42.8%, P = 0.008), longer mean hospital stay (23.8 days, P = 0.004), higher operative mortality (23.1%, P = 0.004) and, unexpectedly, reduced 5 year survival rate (P < 0.0001).
There appeared to be no clear predisposing factor in the development of a chylous leak other than the routine extensive dissection. Although definitive conclusions can not be drawn, where there is early reduction of the initial amount (in this series up to 2.2 l/day) of drainage, there may be a place for successful non-surgical management; in cases of high output chylothorax, persisting after a few days of conservative treatment, however, early re-operation and ligation of the thoracic duct, seems to be advisable.
明确诺丁汉胸外科病房中恶性疾病行食管胃切除术后乳糜胸的发生率、病因、处理方法及影响。
回顾性分析1987年1月至1997年11月间在同一科室采用相似技术及统一围手术期常规管理方法接受食管切除术的523例食管癌或食管胃交界癌患者。
21例患者（4.0%）发生乳糜胸。其中男性12例，女性9例，平均年龄64.7岁（标准差7.5）。单因素及多因素分析显示，年龄、性别、肿瘤部位、长度、组织学类型、壁层浸润深度、淋巴结状态及手术方式均不是显著的诱发因素。17例患者接受保守治疗（4例死亡，23.5%），4例接受手术治疗（1例死亡，25.0%），所有4例手术患者的乳糜漏均得到有效控制。11例乳糜引流量每日达2.2升且在保守治疗1周内减少的患者恢复顺利。然而，其余10例乳糜引流量每日超过2.5升的患者，其发病率、住院时间、手术死亡率及手术干预需求均增加。与其余患者（n = 502）相比，发生乳糜胸的患者（n = 21）有更多的肺部并发症（42.8%，P = 0.008）、更长的平均住院时间（23.8天，P = 0.004）、更高的手术死亡率（23.1%，P = 0.004），且意外的是5年生存率降低（P < 0.0001）。
除常规广泛解剖外，似乎没有明确的乳糜漏诱发因素。尽管无法得出确切结论，但如果初始引流量（本系列中每日达2.2升）能早期减少，非手术治疗可能成功；然而，对于保守治疗数天后仍持续的高流量乳糜胸，早期再次手术并结扎胸导管似乎是可取的。
