腹腔镜淋巴结清扫术后并发乳糜漏的防治

Prevention of chylous leakage after laparoscopic lymphadenectomy

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。

Abstract:

【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. 【Results】 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 occurrence of chylous leakage.