关键词: 食管癌, 食管切除术, 乳糜胸, 胸导管, 预防性结扎

Abstract: Post-esophagectomy chylothorax is uncommon but may cause substantial nutritional,immunologic,and hemodynamic impairment.Whether prophylactic thoracic duct ligation reduces chylothorax and whether it affects long-term outcomes remain controversial.This expert review evaluates thoracic duct anatomy,early recognition,and risk-adapted management of chylothorax,with emphasis on the evolving evidence regarding prophylactic ligation.Although early studies suggested a preventive benefit,recent meta-analyses and propensity-score analyses have not demonstrated consistent improvement,and the effects of ligation,resection,and extended lymphadenectomy remain difficult to separate.Current evidence does not support routine ligation of the thoracic duct when neither ductal injury nor tumor invasion is identified.Precise intraoperative identification and selective repair or ligation of an injured duct or tributary are more appropriate.Postoperative management should escalate from nutritional support to lymphatic intervention or therapeutic ligation according to output trajectory and systemic effects.

Key words: esophageal cancer, esophagectomy, chylothorax, thoracic duct, prophylactic ligation