Clinical application of thoracic duct and vein anastomosis in the treatment of recurrent severe chylous thorax / 临床外科杂志

ABSTRACT

Objective To investigate the potential benefits of thoracic duct vein anastomosis in the management of recurrent and severe chylothorax.Methods According to the drainage volume and presence of thoracic duct injury,63 chylothorax patients admitted to our hospital from January 2014 to December 2021 were divided into two groups:A and B.Among them,a total of 37 patients in Group A had a daily thoracic drainage volume of＜1 000 ml and no thoracic duct injury;a total of 26 patients in Group B had a daily drainage volume of＞1 000 ml and had thoracic duct injury confirmed by lymphangiography.Different methods of intervention such as conservative treatment,thoracic duct ligation or thoracic duct and vein anastomosis are used to intervene,and the patient's symptoms,the characteristics and amount of thoracic closed drainage fluid,postoperative recovery time and prognosis are observed.Results According to multifactor analysis,patients over the age of 60(p＜0.01),with a long history of smoking(p=0.04),prolonged alcohol consumption(p=0.03),and a history of malignancy(p=0.02)exhibited a higher incidence of Group B chylothorax.Most chylothorax cases in Group A were successfully treated using conservative methods.Among the 21 patients in Group B treated through thoracic duct ligation surgery,3 cases showed recurrence of chylothorax.These 3 patients were cured by performing thoracic duct with venous anastomosis.Conclusion Chylothorax cases with a daily drainage volume exceeding 1 000 ml and accompanying thoracic duct injury should be treated promptly and aggressively with surgical intervention.Thoracic duct ligation has shown favorable treatment outcomes for typical chylothorax cases.However,in the event of persistent and recurrent severe chylothorax,a thoracic duct surgery with innominate or odd vein anastomosis may prove to be more effective.