摘要
目的探讨婴儿顽固性乳糜性腹水的病因及治疗方法。方法回顾性分析2001至2014年我科收治的10例乳糜性腹水患儿临床资料，所有患儿均经过腹穿、实验室检查明确乳糜性腹水诊断，均先采用禁食水、联合静脉营养的保守治疗，症状缓解不明显，再采用腹腔镜探查，然后根据术中所见情况采取腹腔镜下或开放途径相应治疗。10例患儿中采用腹腔镜下Ladd手术6例，扩大脐窝切口将小肠提出腹壁外，开放手术Ladd手术3例，1例因肠系膜根部淋巴结破溃乳糜漏行腹腔镜下淋巴结切除。结果所有患儿均行钡灌肠检查，其中回盲部位于右上腹者7例，回盲部在正常的右下腹位置3例。腹腔镜探查下10例患儿均有肠旋转不良改变，其中9例有明显的Ladd韧带压迫，6例实施腹腔镜下Ladd手术，3例实施开放Ladd手术，另外1例因肠系膜根部淋巴结破溃乳糜漏行腹腔镜下淋巴结切除，8例患儿治疗后乳糜性腹水明显缓解，2例术后轻度腹胀，经低脂进食保守治疗3个月后腹胀消失，所有患儿定期随访未见明显复发需要再手术者。结论肠旋转不良系膜根受压是婴幼儿乳糜性腹水形成的重要因素之一，Ladd手术是其治疗的有效方法。
Objective To explore the etiology and treatment of infantile intractable chylous ascites. Methods Retrospective analyses were performed for 10 children with infantile congenital chylous ascites at our center during the period of 2001 and 2014. All cases were preoperatively diagnosed by abdominal paracentesis and laboratory examinations. And conservative measured were offered. Results All had intestinal malrotation. And the Ladd＇s procedures were laparoscopic （n = 6） and traditional open （n = 3）. Another patient with a rupture of mesenteric lymph nodes underwent laparoscopic resection. Cylous ascites subsided postoperatively and there was no overt recurrence during follow-ups. Conclusions Intestinal malrotation is closely associated with infantile congenital chylous ascites. And Ladd＇s procedure is both safe and efficacious for intractable infantile chylous ascites.
出处
《中华小儿外科杂志》
CSCD
2016年第2期131-133,共3页
Chinese Journal of Pediatric Surgery
关键词
乳糜性腹水
婴儿
肠旋转不良
Chylous ascites
Infant
Intestinal malrotation
