The surgical strategy of selective thoracic duct ligation using fluorescence thoracoscopy for the prevention of chylothorax after lung cancer surgery in the elderly
10.3760/cma.j.issn.0254-9026.2025.08.015
- VernacularTitle:荧光胸腔镜下选择性胸导管结扎的手术策略预防老年肺癌术后乳糜胸
- Author:
Wenxin TIAN
1
;
Peng JIAO
;
Yaoguang SUN
;
Hanbo YU
;
Donghang LI
;
Jiangyu WU
;
Hongfeng TONG
Author Information
1. 北京医院胸外科 国家老年医学中心 中国医学科学院老年医学研究院，北京 100730
- Publication Type:Journal Article
- Keywords:
Fluorescence;
Thoracoscopy;
Lung neoplasms;
Thoracic duct;
Chylothorax
- From:
Chinese Journal of Geriatrics
2025;44(8):1107-1113
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the impact of the surgical strategy of selective thoracic duct(TD) ligation established through fluorescence thoracoscopy TD imaging technology on the occurrence of chylothorax after lung cancer surgery in the elderly.Methods:A prospective cohort study was conducted.Elderly patients who underwent right lung cancer surgery in the Department of Thoracic Surgery of Beijing Hospital from October 2023 to June 2024 were enrolled as the research subjects.The surgical approaches involved pulmonary resection, systematic lymphadenectomy, and selective TD ligation using fluorescence thoracoscopy.Prior to the surgery, 0.4 mg/kg indocyanine green(ICG)was injected subcutaneously into the right inguinal region of all patients.Clinical data, surgical details, pathological information, and intraoperative TD imaging, including the course, collateral vessels, and any injuries, were collected.Postoperative chylothorax and other complications were also recorded.Results:A total of 83 patients were enrolled, of which 38 were males, and 45 were females, with a median age of 68 years raging from 60 to 83 years old, TD imaging was observed in 69 cases(83.1%)within one hour after IGC injection.Intraoperative injuries of collateral branches were visualized in 4 cases(4.8%). Among them, 2 cases had injuries in both the 2R+ 4R and the subcarinal station, while 2 others had injuries of collateral branches only in the 2R+ 4R station.These 4 patients underwent concurrent TD ligation.No TD or collateral injury was found in the remaining patients during the surgery, and the TD was not ligated, none of the patients developed chylothorax postoperatively, and no adverse reactions related to indocyanine green were observed.Conclusions:Fluorescence thoracoscopy-guided TD imaging technique can well visualize TD and its collateral injuries in elderly lung cancer surgeries, assist in the management of leaks or TD ligation, thereby effectively preventing the occurrence of postoperative chylothorax.
