食管癌手术患者预防性结扎胸导管的研究(1)
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【摘要】 目的 探讨食管癌切除患者术中预防性结扎胸导管的免疫学依据。方法 200例 0-Ⅲ期的食管癌切除患者术中预防性结扎了胸导管, 随访3月-1 年( 随访率89.7%)。随机抽取胸导管结扎70例患者, 与同期随机抽取30例未结扎患者作为对照,术前、术后1周分别进行血清载脂蛋白电泳测定,术后3周内抽取外周血用碱性磷酸酶抗碱性磷酸酶( APAAP )法进行检测 CD3 +、CD4+ 、CD 8+、CD16 + 56 + T淋巴细胞。结果 胸导管结扎组与未结扎组术后各期CD3 +、CD4+ 、CO8+、CD16 + 56 + T淋巴细胞均无显著性差异(P>0.05 );随访病例未发现淋巴淤积及水肿现象。结论 胸导管结扎是预防食管癌术后乳麋胸发生的有效方法,并不会影响患者的细胞免疫,亦不会对淋巴回流造成严重后果。
【关键词】 食管癌;胸导管结扎;乳糜胸; 淋巴回流
【中图分类号】R735.1 【文献标识码】 A 【文章编号】1005-0515(2010)007-001-03
Preventive surgery in patients with esophageal ligation of thoracic duct
City Guangdong Province Gouzhou People's Hospital(525200)
Lin WanliChen Ying He Haiquan Xie xihao
【Abstract】 Objective Resection of esophageal cancer surgery in patients with thoracic duct ligation in the prevention of immunological basis.Methods 200 cases of 0 - Ⅲ stage esophageal cancer resection surgery in patients with preventive ligation of the thoracic duct, follow-up in March -1 years (follow-up rate 89.7%). Randomly selected 70 patients with thoracic duct ligation in patients with the same period 30 cases of randomly selected patients without ligation served as controls, before surgery, 1 week respectively electrophoresis of serum apolipoprotein determi,Taken within 3 weeks after peripheral blood with alkaline phosphatase anti-alkaline phosphatase (APAAP) method for detection of CD3 +、CD4+ 、CD 8+、CD16 + 56 + Tlymphocytes.Results Thoracic duct ligation group and non-ligation group at each period of CD3 +、CD4+ 、CO8+、CD16 + 56 + T lymphocytes had no significant difference(P>0.05 );Follow-up found no cases of lymph deposition and edema.Conclusion The prevention of thoracic duct ligation thoracic esophageal cancer after breast Mi effective way to place, and will not affect the patient's cell-mediated immunity, and will not be lymphatic flow have serious consequences.
【Key words】Esophageal cancer; thoracic duct ligation; chylothorax; lymphatic flow
胸导管是全身最大的淋巴管,起始于第一腰椎附近的乳糜池,经后纵隔上行,在左颈根部注入左静脉角。胸导管的生理功能是递送乳糜液,使之流入血循环。乳糜胸是开胸手术后较常见且病死率较高的并发症之一。故其预防极其重要。迄今为止,尚无最佳预防及治疗方案。常规的治疗方法是先保守治疗,无效后再开胸结扎胸导管。但多数疗效不满意,病死率较高,且再次开胸结扎胸导管的危险性极高 ......
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