结肠癌D3清扫术后腹腔乳糜漏的病因预防及治疗分析

Investigation of the etiology, treatment, and preventive experience of the chyious fistula after radical re- section of colon carcinoma plus D3 lymph node dissection

目的总结结肠癌D3清扫术后腹腔乳糜漏的病因、治疗及预防经验。方法对628例行结肠癌D3清扫术后发生乳糜漏病例进行回顾性分析，比较不同术式（开腹组与腹腔镜组）、不同部位（右半结肠与左半结肠）乳糜漏的发生率。结果22例结肠癌患者（3．5％）术后发生乳糜漏，开腹组与腹腔镜组的发生率分别为2．8％（8／286）和4．O％（14／342），差异无统计学意义（P〉0．05）；右半结肠D3清扫术后腹腔乳糜漏发生率为7．8％（16／207），左半结肠D3术式乳糜漏发生率为1．4％（6／421），两组相比，差异具有统计学意义（P〈0．05），乳糜漏的发生与肿瘤的TNM分期无明显关系。21例患者经保守治疗（治疗方法包括禁食、肠外营养、静脉使用生长抑素、抗感染治疗和延缓拔除腹腔引流管），均获治愈，1例行腹腔淋巴管漏口结扎术并局部使用医用胶治愈，无复发及死亡病例。结论结肠癌D3清扫术开腹与腔镜在预防腹腔乳糜漏方面无明显差异，右半结肠D3术式是乳糜漏的高危因素，术后腹腔乳糜漏保守积极治疗有效。

Objective To summarize the etiology,treatment and preventive experience of the chylous fis- tula after radical resection of colon carcinoma plus D3 lymph node dissection. Methods 628 cases of the chylous fistula after radical resection of colon carcinoma plus D3 lymph node dissection were analyzed retrospectively. The incidence of the chylous fistula in different surgical methods（ the Laparotomy Group and the laparoscopy group） and different surgical sites （left colon cancer and right colon cancer）was compared. Results Chylorrhea occurred in 22 patients （3.5 % ）, including 2.8 % （ 8/286 ） in the Laparotomy Group and 4.0 % （14/342） in the Laparotomy Group, and the differences were no statistical significance （P 〉 0.05 ）. Incidence of the chylous fistula in radical resection of right - colon carcinoma plus D3 lymph node dissection was 7.8% （ 16/207 ） ,while incidence of the chylous fistula in radical resection of right - colon carcinoma plus D3 lymph node dissection was 1.4% （6/421）. There was statistical significance （P 〈 0.05 ）, and there was no significant statistical significance between different TNM stages and incidence of the chylous fistula（P 〉 0.05 ）. Twenty - one patients received conservative treat- ment（ abrosia, total parenteral nutrition, somatostatin infusion, anti - infection, delaying removing drainage tubes） were successfully cured, and one patient required re - operation. No patients had recurrence and died. Conclusion There is no statistical significance between the Laparotomy Group and the laparoscopy group. Radical resection of right - colon carcinoma plus D3 lymph node dissection is associated with higher risk for chyle leak. Conserva- tive treatment is effective in early stage of chyle leak after radical resection of colon carcinoma plus D3 lymph node dissection.