食管癌术后乳糜胸诊疗的研究进展

doi:10.3969/j.issn.1674-8115.2023.02.015

摘要/Abstract

摘要：

胸导管是人全身最长的淋巴导管，在维持人体正常物质代谢和免疫功能方面发挥着重要作用。食管切除术中损伤胸导管致淋巴乳糜液外漏并积存于胸膜腔，引起乳糜胸，是食管癌术后一个罕见的并发症。其病因可能与解剖学变异、患者自身情况、肿瘤分期、围术期干预等因素相关，术前、术中采取一些预防措施可以减少乳糜胸的发生。尽管发病率低，但误诊或处理不当可能会导致严重的代谢紊乱、增加手术相关并发症甚至致死的可能。因此，早期的诊断和及时干预尤为重要。诊断需以临床表现为主要依据，辅以实验室检查和影像学检查综合判断。治疗方面目前尚无统一标准，主要包括保守治疗、介入治疗和外科治疗，需根据实际情况综合判断，选择适宜的治疗方式。近年来介入技术发展迅猛，可精准定位乳糜胸的位置，有望在乳糜胸的治疗中发挥更重要的作用。该文就食管癌术后乳糜胸的病因、诊断、治疗和预防方面的最新进展进行综述，并提供流程图式的治疗步骤，旨在为更有效地处理该并发症提供参考。

关键词: 食管癌, 乳糜胸, 胸导管

Abstract:

Thoracic duct is the longest lymphatic duct in the human body and plays an important role in maintaining normal metabolism and immune function. Chylothorax is a rare complication after esophageal surgery, which is caused by the injury of the thoracic duct during esophagectomy, resulting in the accumulation of chyle in the pleural cavity. The etiology may be related to anatomical variation, patient's general condition, tumor stage, perioperative intervention and other factors. Preoperative and intraoperative preventive measures can reduce the incidence of chylothorax. Although the incidence rate is low, misdiagnosis or unsuccessful management can increase postoperative complications and lead to serious metabolic disorders and even death. Therefore, early diagnosis and intervention are of paramount importance. Diagnosis should be based on clinical manifestations, supplemented by laboratory and imaging studies. Currently, there is no standard for treatment, which mainly includes conservative treatment, interventional treatment, and surgical treatment. It is necessary to make a comprehensive judgment according to the actual situation and select the appropriate treatment method. In recent years, interventional technology could accurately localize the chylothorax, which is expected to play a more important role in the treatment of chylothorax. This article reviews the latest advances in the etiology, diagnosis, treatment, and prevention of chylothorax after esophagectomy and provides a flow chart of treatment steps to effectively manage this complication.

Key words: esophageal cancer, chylothorax, thoracic duct

中图分类号:

R655.4

王新宇, 赵晓菁, 唐健. 食管癌术后乳糜胸诊疗的研究进展[J]. 上海交通大学学报（医学版）, 2023, 43(2): 244-249.

WANG Xinyu, ZHAO Xiaojing, TANG Jian. Research progress in diagnosis and treatment of chylothorax after esophagectomy[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(2): 244-249.

图/表 1

参考文献 45

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