Clinical Application Of Routine Ligation Of Thoracic Duct For Prevention Of Postoperative Chylothorax In Esophageal Cancer

BackgroundEsophageal cancer is a malignant digestive tract tumor with high incidence in China.Due to various factors,its morbidity and mortality are increasing year by year.At present,surgical treatment is still the first choice for the treatment of esophageal cancer,but due to its anatomical and physiological specificity,the difficulty of surgery is increasing,and the incidence of postoperative complications and mortality are high.Postoperative complications such as chylothorax,anastomotic leakage,anastomotic stenosis,gastroesophageal reflux,digestive tract hemorrhage,pulmonary infection,etc.Chylothorax is one of the most serious complications after surgical treatment of esophageal cancer,The incidence is 0.1%-4% reported abroadly,and the incidence reported in some domestic literature is 0.9% to 11.6%,which increases the risk of surgery.Once the patient has a chylothorax after radical resection of esophageal cancer,a series of complications will occur,which will increase burdens on the patients,reduce the patient's confidence in disease resistance,seriously affect the patient's prognosis,and ultimately lead to death.ObjectiveTo investigate the clinical application of conventional thoracic duct ligation in the prevention of chylothorax in radical resection of esophageal cancer.MethodsRetrospective analysis of 636 patients with esophageal cancer who were eligible for the study.241 patients with non-ligated thoracic ducts who were enrolled in the study from January 2007 to January 2009,395 patients who were enrolled in this study from January 2015 to January 2017 underwent low ligation of the thoracic duct ligation in the study group.The incidence of chylothorax during hospitalization was observed and compared between the two groups.ResultsThere were no significant differences in age,gender,esophageal lesion location,and TNM staging between the two groups(P>0.05).There was no significant difference in the intraoperative blood loss,pull out the thoracic drainage tube time,and surgery time.(P>0.05).The difference in postoperative hospital stay between the two groups was statistically significant(P<0.05).The difference in the probability of chylothorax after radical resection of esophageal cancer was statistically significant(P<0.05).There were 5 cases of chylothorax in the non-ligation group and 0 case in the ligation group.The incidence of ligation group was significantly higher than that of non-ligation.Five patients with chylothorax were treated conservatively for 5 days,and one case of chyle drainage was significantly reduced.Continue to treat conservatively;After 5 days of conservative treatment,the amount of lavage fluid drained from the chest drainage tube was not significantly reduced.All of them were operated again with open chest and thoracic duct ligation at the T9 or T10 level.ConclusionRoutine lower thoracic duct ligation can effectively reduce the incidence of chylothorax.