thoracic duct ligation

The upper and lower thoracic ducts are attached to the mediastinal pleura, so the chest duct injury with the mediastinal pleural injury can cause the left chylothorax or the right chylothorax. Thoracic catheter can prevent postoperative chylothorax. In 1948, Lamp-son comprehensively reported the successful experience of thoracic duct ligation in the treatment of chylothorax, which greatly improved the treatment effect of chylothorax and reduced the mortality rate to about 10%. Treatment of diseases: chylothorax Indication If a chest tube is found in a chest surgery, the chyle leaks out, or the chest tube is highly suspected, the thoracic duct can be ligated at a low position. Contraindications If there is no obvious sign of damage to the thoracic duct, it is not advisable to ligature the thoracic duct, and high ligation should be avoided. Preoperative preparation In addition to active support therapy, strengthen the drainage of pleural fluid, prevent infection and other measures, in order to facilitate the intraoperative display of thoracic duct fistula, take 200ml of milk 3~4h before surgery, or 50ml of vegetable oil, or inject a sputum dye through the stomach tube. Olive oil, etc.; if necessary, subcutaneous injection of azo blue (Evans blue) or lymphangiography to help display the thoracic duct or its mouth. Surgical procedure 1 surgical path: unilateral chylothorax, can be inserted into the chest through the posterior lateral incision of the 6th or 7th intercostal space; bilateral chylothorax can be operated through the right thoracic approach, if necessary, through the left chest approach; The posterior chylothorax was inserted into the chest through the same surgical incision. 2 Surgical points: After entering the chest, first absorb the chyle, remove protein clots and cellulose deposits, rinse the chest with saline, absorb and wipe with gauze; remove the gauze and observe the mediastinum with or without milky white liquid leakage; Follow the outflow site of the milky white liquid to find the thoracic duct fistula; after finding the fistula, reveal the thoracic duct at the upper and lower ends of the fistula, and double suture; due to cellulose deposition and tissue edema, it is difficult to reveal the thoracic duct. Filling is not satisfied, and it is very fragile. In this case, it is best to close the ends of the vertebral body beyond the mouth of the sputum, and double-sew together with the surrounding tissue, taking care not to hurt the esophagus; after sewing, wipe with gauze In the mediastinum, remove the gauze to see if there is still chyle leakage, to determine whether the thoracic duct ligation is effective, and then ligature the thoracic duct at the lower iliac crest. Sometimes it is difficult to find the fistula. It is not necessary to force it. The ligation of the upper thoracic catheter can also be effective. . If you enter the chest from the left side, pull the esophagus forward and press the lower part of the descending aorta backward. Between the aorta and the azygosic vein, the thoracic catheter can be found in front of the 7th and 8th thoracic vertebral bodies. The thoracic catheter is about 3mm wide, and the wire is double-ligated at both ends. A 0.5mm thoracic catheter is removed in the middle, and the pathological examination can confirm the accuracy of ligation. If you enter the chest from the right side, the chest tube is easier to expose and ligature. If the difficulty is revealed, it can also be sewed together with the surrounding tissue at the anatomy of the thoracic duct. Electrocoagulation is unreliable and should not be applied. Because the anterior mediastinum and lymphatic vessels around the thymus can also involve the right lymphatics, thoracic duct ligation can sometimes be ineffective.