胃癌根治术后乳糜漏的治疗

Management of chylous leakage after radical operation of gastric cancer

目的分析和探讨胃癌根治术后乳糜漏发生发展的规律及治疗预防方法。方法前瞻性地对161例胃癌患者行 D2～D4胃癌根治术,术中常规每一例患者于腹腔动脉及腹主动脉膈肌角附近放置双套管引流一根。术后密切观察引流管中乳糜液的情况,行乳糜液的微生物涂片和培养,对有感染的乳糜液进行抗感染治疗。观察乳糜漏的发生发展规律,明确引流管拔除的时机。结果161例进行 D2～D4胃癌根治术患者,19例发生乳糜漏,引流量小于250 ml/24 h 8例,250～500 ml/24h 7例,500～1500 ml/24 h 4例。8例引流液中有大量白色假丝酵母菌生长,其中5例合并细菌生长。乳糜漏均于术后10～90 d 痊愈。乳糜漏的引流管在引流量几乎为零;感染乳糜液治疗后乳糜液为乳白色,无菌生长;B 超腹腔无积液,患者一般情况良好,无感染表现,即可拔管。结论胃癌 D2～D4术后发生乳糜漏后,如及时发现,充分引流,合并真菌或细菌感染时抗感染治疗及局部持续冲洗,乳糜漏可痊愈。

Objective To investigate the management of chylous leakage after radical operation of gastric carcinoma. Methods 161 patients with gastric carcinoma underwent D2-D4 dissection. A double catheterization cannula was employed in each patient around the abdominal aorta above the celiac trunk and crus of diaphragm. Postoperatively, the chylous fluid from the drainage tube was observed, smeared and cultured; infection of chylous fluid was treated. The development of chylous leakage was observed and the optimal time to remove the drainage tube was determined. Results Chylous leakage occurred in 19 patients. The volume of chylous leakage was less than 250 ml / 24 h in 8 patients, 250 - 500 ml / 24 h in 7, and 500 -1500 ml/24 h in 4. Candida albicans was founded in the fluid of chylous leakage in 8 patients, and bacterial infection was found simultaneously in 5 of them. The patients with chylous leakage were healed within 10 -90 postoperative days. The drainage tube was removed when there was no fluid in the tube and no hydrops in peritoneal cavity by B ultrasound, and the patient were in good condition without signs and symptoms of infections. Conclusion Chylous leakage after D2-D4 dissection for gastric carcinoma can be cured by immediate diagnosis, thorough drainage, and anti-infectious treatment with regional and continuative washout when the chylous fluid is infected by Candida or bacteria.