背景术后乳糜胸是一种罕见但危及生命的食管切除术并发症。然而,由于它的稀有性,研究危险因素和选择合适的治疗方案一直受到限制。方法本研究纳入了在我院接受微创食管癌切除术的727例食管癌患者。检测乳糜胸的危险因素,我们把病人分成两组,术后有无乳糜胸。然后我们比较了患者的特征,肿瘤特异性变量,和操作细节。随后,我们分析了我们选择的三种不同治疗方案的围治疗特征和结果:手术,转换(保守治疗失败后最终接受手术的组),和保守。结果727例患者中,18(2.5%)发展为乳糜胸。平均BMI较低(20.3vs.21.9,p=0.057),乳糜胸组进行胸导管切除的病例较多(33.3%vs.6.2%,p=0.001),具有统计学意义。多变量分析确定胸导管切除术是一个危险因素(调整后的比值比,6.83).手术组乳糜胸术后两天的引流量较高,虽然差异无统计学意义(手术组,1,405mlvs.转换组,260毫升vs.保守团体,310ml;p=0.073)。在这些组中,手术组的中位术后住院天数最短(21.5天,而转换组和保守组的102天和25.0天,分别为;p<0.001)。没有患者在住院期间死亡。结论初次微创食管癌切除术中胸导管切除术是乳糜胸的独立危险因素。如果排水量在第二天没有减少,早期手术可能导致更早出院。
Background Postoperative
chylothorax is a rare but life-threatening complication of esophagectomy. However, due to its rarity, researching the risk factors and selecting appropriate treatment options has been limited. Methods This study included 727 patients with esophageal cancer who underwent minimally invasive esophagectomy at our hospital. To detect the risk factors for
chylothorax, we divided the patients into two groups, with and without postoperative
chylothorax. We then compared patient characteristics, tumor-specific variables, and operative details. Subsequently, we analyzed the peri-treatment characteristics and outcomes for the three distinct treatment options we had chosen: surgery, conversion (the group that finally underwent surgery after unsuccessful conservative treatment), and conservative. Results Of the 727 patients, 18 (2.5%) developed a
chylothorax. The mean BMI was lower (20.3 vs. 21.9, p=0.057), and more cases of thoracic duct resection were found in the chylothorax group (33.3% vs. 6.2%, p=0.001), with statistical significance. Multivariate analysis identified thoracic duct resection as a risk factor (adjusted odds ratio, 6.83). The drainage volume two days after
chylothorax was higher in the surgery group, although the difference was not statistically significant (surgery group, 1,405 ml vs. conversion group, 260 ml vs. conservative group, 310 ml; p=0.073). The surgery group had the shortest median postoperative hospital days among these groups (21.5 as compared to 102 and 25.0 days in the conversion and conservative groups, respectively; p<0.001). None of the patients died during their hospital stays. Conclusion Thoracic duct resection during the initial minimally invasive esophagectomy was an independent risk factor for chylothorax. If drainage volume does not decrease on the second day, early surgery may lead to earlier discharge.