Objective To investigate the optimal, surgical indications, approaches and procedures for iatrogenic chylothorax. Methods The clinical data of 46 cases with operative chylothorax after thoracic surgery were analyzed, including 36 cases of mid-upper esophageal cancer,6 cases of lung cancer,3 cases of mediastinal tumor and 1 case of adult patent ductus arteriosus. On the 6th ～41st day after surgery, all patients were reoperated to ligature the thoracic duct trunk or suture the leakage site, 3 cases underwent a third thoracotomy. Results Forty-four patients were cured(95. 6%),the complication rate was 43. 5% , and 2 patients died(4. 4%). Forty cases were followed up for 1 ～ 3 years and there was no recurrent chylothorax. Conclusion Re-operation should be performed in cases of iatrogenic chylothorax following recent post - thoracic surgery with conservative treatment, in which 24-hour chest drainage is ＞ 1500 ml for 3 days, with no reduction trend. The right thoracic approach iss the first choice for the surgery because it could clearly reveal the thoracic duct trunk. In very extreme cases which fail the reoperation,the lariat and thoracic aorta could be dissociated through the left thoracic approach, and the missing thoracic duct could be revealed and ligated in the area between aorta and vertebra. The optimal approaches are the ligation of thoracic duct above the diaphragm and the suture of massive tissue. Surgeons should try their best to find and suture the chyle fistula.%目的 探讨医源性乳糜胸的最佳手术时机、径路和术式.方法 分析46例胸内脏器近期手术后并发乳糜胸的临床资料,含食管中上段癌36例,肺癌6例,纵隔肿瘤3例,成人动脉导管未闭症1例.术后6～41d,经再次开胸行胸导管主干结扎或漏口缝扎;另有3例行第三次开胸手术.结果 治愈44例(95.6%),发生并发症20例,并发症率43.5%,死亡2例(4.4%).随访获40例,随访时间1～3年,均未有乳糜胸复发.结论 胸内脏器近期手术后并发乳糜胸,经保守治疗,24h胸液引流量＞1500ml连续3d,且无减少趋势,宜再手术;手术首选右胸径路(80%),可清楚显露胸导管主干,对极个别再次手术失败的病例,经左胸游离套索带牵开胸主动脉,显露主动脉椎体夹沟内被遗漏的胸导管予以缝扎.术式以膈肌上胸导管结扎或大块组织缝扎为主,同时争取发现和缝扎乳糜漏口.
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