摘要
目的探讨腹腔镜淋巴结清扫术后乳糜漏发生情况、发展规律及防治方法。方法回顾该院2006年7月-2013年9月行腹腔镜淋巴结清扫术后并发乳糜漏13例患者(肾癌6例,胃癌4例,卵巢癌2例,子宫内膜癌1例),分析其乳糜漏的发生、发展规律,明确恰当的处理措施及引流管拔除的时机。结果 3例(肾癌2例,胃癌1例)患者术后第2天即可见大量乳白色引流液,采取禁食、全胃肠外营养(TPN)、生长抑素、保持通畅引流等方法治疗约1个月后治愈;其余10例患者均于术后恢复饮食后出现乳糜漏,调整饮食、通畅引流后约于治疗后2周治愈。当乳糜漏的引流管引流量几乎为零,B超检查提示腹腔无积液,患者无感染表现,即可拔管。结论腹腔镜淋巴结清扫术后发生乳糜漏,若及时发现,采用控制饮食、TPN、充分引流等非手术治疗,乳糜漏可痊愈。术者熟练掌握腹腔镜技术、熟悉清扫区域解剖,术中仔细电凝、彻底闭合损伤淋巴管,术后常规留置引流管,预防性控制饮食可有效预防乳糜漏的发生。
[ Objective ] To investigate the development and management of chylous leakage after the laparoscopic lymphadenectomy. [ Methods ] 13 cases of chylous leakage patients were retrospectively analyzed from July 2006 to September 2013, 6 cases of kidney cancer, 4 cases of gastric cancer, 2 cases of ovarian cancer, 1 case of endometrial cancer, the appropriate treatment was looked for and the timing of the drainage tube removed. [ Resuits ] A lot of milky fluid drainage was seen in 3 cases （2 cases of kidney cancer, 1 case of gastric cancer） after the first two days postoperation and cured about 1 month later due to taking fasting, total parenteral nutrition, somatostatin, maintaining unobstructed drainage and other methods of treatment; 10 cases were chylous leakage after recovery diet and cured in about 2 weeks after treatment by changes in diet, unobstructed drainage etc. The drainage liquid was significantly reduced, no hydrops inperitoneal cavity was found by B ultrasound, and the patients were in good condition without signs and symptoms of infections. [ Conclusion ] Chylous leakage occurs infrequencely after the para-aortic lymph node dissection; It is able to be cured by immediate diagnosis, fasting, TPN and drainage . Surgeons should be familiar with laparoscopic techniques and regional anatomy, be careful of coagulation and occluded gradually, and indwell drainage tube routinely, control diet preventively can effectively prevent the occur- rence of chylous leakage.
出处
《中国内镜杂志》
CSCD
北大核心
2014年第12期1284-1288,共5页
China Journal of Endoscopy
关键词
乳糜漏
腹腔镜
淋巴结清扫术
chylous leakage
laparoscopy
lymphadenectomy
