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目的探讨食道贲门癌手术中预防和及时发现胸导管损伤的对策。方法对143例食道贲门癌手术患者常规结扎胸导管。对全部病例采用术前口服奶油及术中连续静点5％脂肪乳剂的方法来判断有无胸导管损伤,如创面有白色液体溢出,则判定为有胸导管损伤。结果 143例食道贲门癌病例中有10例食管下段癌,1例中段癌及1例贲门癌术中在分离肿瘤周围组织和食管床时见有白色液体溢出,确定由胸导管损伤随行双重结扎之。术后未发生1例乳糜胸并发症。结论手术中常规结扎胸导管和术前口服奶油,术中连续静点5％脂肪乳剂,判断有无胸导管损伤, 这一方法对食管贲门癌手术中胸导管损伤的防治有一定的价值,此法简单易行、可靠。
Objective To investigate the prevention and timely detection of thoracic duct injury during esophageal and cardiac surgery. Methods 143 cases of esophageal and cardiac surgery patients with conventional thoracic duct ligation. All cases were treated with preoperative oral cream and intraoperative continuous static 5% fat emulsion method to determine the presence or absence of thoracic duct injury, such as the wound white liquid overflow, it was diagnosed with thoracic duct injury. Results In 143 cases of esophageal and cardiac cancer, 10 cases of esophageal lower segment carcinoma, 1 case of middle segment carcinoma and 1 case of cardia cancer were found to have overflow of white liquid during the separation of tumor surrounding tissue and esophageal bed. It was confirmed that thoracic ductal injury accompanied by double ligation . No postoperative chylothorax occurred in 1 case. Conclusions During operation, conventional thoracic catheterization and preoperative oral cream, intraoperative continuous static point of 5% fat emulsion to determine the presence or absence of thoracic duct injury, this method for the prevention and treatment of thoracic duct injury in esophageal and cardial cancer surgery has some value, this Law is simple and reliable