肺癌术后乳糜胸诊治剖析.docVIP

肺癌术后乳糜胸诊治剖析 　　[摘要] 目的 分析肺癌术后乳糜胸临床特征，总结诊治经验。方法 整群选取该院于2011年2月―2015年12月收治的肺癌手术患者237例，其中发生术后乳糜胸24例，未发生213例，怀疑为乳糜胸者，采集积液进行乙醚震荡实验、成分检查、乳糜检测，采用保守治疗，据引流量3例采用胸导管结扎术治疗，12例胸腔闭式引流。结果 发生率1.0%（24/237），发生乳糜胸者开胸术手术率（25.0%）低于未发生者（53.5%），差异有统计学意义（P0.05）；术后住院时间（8.4±2.2）d，积液消失，随访30 d，未见复发。 结论 肺癌术后乳糜胸诊断并不困难，保守、手术都可治疗乳糜胸，疗效肯定。 　　[关键词] 肺癌；乳糜胸；诊断；治疗 　　[中图分类号] R734 [文献标识码] A [文章编号] 1674-0742（2017）01（b）-0057-03 　　[Abstract] Objective To analyze the clinical features of chylopleura after the lung cancer operation and summarize the diagnosis and treatment experiment. Methods 237 cases of operative patients with lung cancer admitted and treated in our hospital from February 2011 to December 2015 were group selected， including 24 cases with chylopleura after the lung cancer operation and 213 cases suspected with chylopleura after the lung cancer operation， and the aether shock experiment， component examination and chyle test were conducted by collecting the effusion， and the conservative treatment was adopted， according to the volume of drainage， 3 cases were treated with ligation of thoracic duct and 12 cases adopted the thoracic close drainage. Results The incidence of 1.0%（24/237）， the operative rate of thoracotomy of patients with chylopleura was lower than that of patients without chylopleura，（25.0% vs 53.5%）， and the difference had statistical significance（P0.05）， the postoperative length of stay was（8.4±2.2）d， and the effusion disappeared， and 30d follow-up showed that there was no recurrence. Conclusion The diagnosis of chylopleura after the lung cancer operation is not difficult， for the symptoms after tube drawing， and the chylopleura can be treated with conservative method and operation， and the curative effect is positive. 　　[Key words] Lung cancer； Chylopleura； Diagnosis； Treatment 　　肺癌是三大恶性肿瘤之一，在我国是发病率最高的恶性肿瘤，男性肺癌发病率约为42.4/10万，女性约为19/10万，因肺结核患者波动上升、尘肺发病率上升、吸烟人群增多、城市空气环境恶化，肺癌发病率仍呈快速上升趋势[1]。手术是治疗非肺癌的主要方法，近年来因社会大众体检意识增强，诊断技术的进步，肺癌早期诊断率明显上升，绝大多数肺癌患者都有手术机会[2]。但手术具有创伤性，乳糜胸是肺癌术后少见