胃癌根治术后腹腔淋巴漏的临床诊治经验

Chyloperitoneum after radical gastrectomy: a report of 20 cases

目的:总结胃癌淋巴结清扫术所致的淋巴漏诊治经验。方法:回顾性分析我院2001年1月至2007年12月收治的20例因胃癌行胃癌根治术(D2及D2以上)并发术后淋巴漏病人的临床资料,并复习相关文献。结果:胃癌术后淋巴漏的发生率为0.69%,发生淋巴漏的时间平均为术后第5(4～8)天;每天最大引流量为8200mL。18例病人经保守治疗痊愈;2例再次手术治疗,其中1例淋巴漏未愈最终衰竭死亡,另1例虽获治愈,但术后住院天数(61d)明显大于保守治疗组(38d)。结论:胃癌术后淋巴漏应以术中预防为主;治疗首选支持及保守治疗,尽量避免于短期内进行二次手术。

Objective To analyze the experience concerning the diagnosis and treatment of chyloperitoneum after radical gastrectomy. Methods Retrospective analysis was carried out for the 20 patients complicated by postoperative chyloperitoneum among the undergoing radical gastrectomy （D2 or above D2） from Jan 2001 to Dec 2007. Results The incidence rate of chyloperitoneum after radical gastrectomy was 0.69% ,the average occurrence time was the 5th postoperative days, the earliest being the 4th day and the latest the 8th day, the maximum drainage volume was 8200 mL per day. Eighteen patients were cured by conservative treatment; 2 patients were treated by reoperation, among whom 1 patient died of MOSF, another patient was cured, with a hospital-stay of 61 days, significantly longer than the conservative treatment group（38 days）. Conlcusions The chyloperitoneum after radical gastrectomy should be prevented by careful manipulation during the operation; conservative treatment is the first choice for treating chyloperitoneum after radical gastrectomy; reoperation should mostly be avoided within a short period after the radical operation.