Treatment principles
1.Treat the original disease.
2.Low fat diet.
3.Intravenous supplementation of fat milk, albumin, etc.
4.Thoracic aspiration or closed drainage of the chest cavity.
5.Surgical treatment is feasible if medical treatment is ineffective.
Medication principles
1.Celiac disease caused by tuberculosis, the basic drugs 4-7 and 1 can be chosen.
2.For celiac disease caused by filarial granuloma, basic drugs 1-3 and furazolidone can be chosen.
Treatment method
Once celiac disease is diagnosed, fasting, blood transfusion, intravenous rehydration, and high nutritional support should be taken immediately. Thoracentesis or closed drainage can make the lung completely expand. Those caused by malignant tumors should treat the tumor with radiation. 1/2 patients can be treated conservatively, while the other 1/2 patients need surgery.
Conservative treatment methods
1.Fastening, intravenous rehydration, high nutritional support, closed drainage of the chest cavity;
2.Use growth inhibitors to inhibit celiac production;
3.Intra-thoracic injection of pleural adhesives to promote pleural adhesions to close the thoracic duct fistula;
4.After successful treatment, gradually resume normal diet.
Surgical treatment methods
1.Surgical indications.
The onset of the disease is urgent and caused by trauma; progressive increase in pleural fluid, caused by the failure to reduce; the general condition is still good, not caused by malignant tumor invasion; conservative treatment is ineffective, should be given active surgery.
2.Preoperative preparation: fully correct malnutrition and electrolyte disorder before surgery, give blood transfusion, high protein, control respiratory tract infection, and give high-fat diet 3~4 hours before surgery, which helps to find the thoracic duct and its breakage site during surgery.
3.Surgical treatment
(1) Anesthesia tracheal intubation intravenous complex anesthesia.
(2)The lying position is often taken as left lying, right side surgery, or left side surgery can be done.
(3)Ligation of chest tube through the right chest
The right posterior lateral incision is made through the 5th or 6th intercostal space into the chest, aspirate the intrathoracic fluid, push the lung forward, expose the posterior mediastinum, look for a white translucent 4~5mm thick thoracic duct between the odd vein and the aorta, double ligate it with thick thread at both ends of the breach, then aspirate the fluid with gauze and carefully observe for leakage.
(4) Ligation of thoracic duct via left chest
Then the mediastinal pleura is cut above the aorta, and the thoracic duct is found behind the subclavian artery and double ligated. If the rupture is under the aortic arch, the thoracic duct is found between the odd vein and the aorta and ligated according to the right approach to the chest.
(5) Surgical results except for those caused by malignant tumor invasion and compression, the patient generally heals well after proper surgical ligation.
〖Complications〗
1.Anastomotic fistula: This is a serious complication of esophageal cancer after surgery, with an incidence rate of about 5%. The reasons for its occurrence are related to the anastomosis method, the tension of the anastomosis, the secondary infection of the anastomosis and the nutritional status of the patient before surgery. Anastomotic fistula usually occurs 4-6 days after surgery, or later. Once it occurs, timely and adequate drainage or reoperation should be performed.
2. Anastomotic stenosis: It occurs mostly 2 to 3 weeks after surgery, or as late as 2 to 3 months later, and patients mainly have varying degrees of dysphagia. The anastomotic stricture is related to the anastomotic method, anastomotic infection, anastomotic leakage and the patient’s own scar body.
3.Pulmonary complications: most of the patients with esophageal cancer are of higher age and often have different degrees of pulmonary diseases. Once pulmonary infection occurs, the dosage of antibiotics should be increased, and drug sensitivity test and sputum culture should be performed to select sensitive antibiotics. Give sputum-cleansing drugs to facilitate coughing up of sputum, and perform nasal catheter aspiration or fiberoptic bronchoscopy aspiration if necessary.
4.Pustulothorax: Since bacteria exist in the esophagus under normal circumstances, esophageal cancer surgery is a contaminated surgery and can be complicated by pustulothorax after surgery. The treatment principle of abscess chest is to perform closed drainage of chest cavity and apply antibiotics.
5.Celiac disease: The thoracic duct is an anatomical structure for draining the abdominal cavity and part of the thoracic lymphatic fluid, which is accompanied by the esophagus and may be damaged during surgery. If the tumor invasion is obvious, it is more likely to be damaged. Thoracic duct injury is manifested by celiac fluid draining from the thoracic cavity, with a daily drainage rate of 500 ml or more. Once the diagnosis of celiac disease is confirmed, closed drainage of the chest cavity should be performed and observed for 1 to 2 days.
〖Prevention of common sense〗
Celiac disease is caused by blockage or rupture of the thoracic duct causing celiac fluid to accumulate in the chest cavity.