结肠癌完整系膜切除术后腹腔乳糜漏的临床分析

CLINICAL INVESTIGATION OF CHYLOUS FISTULA AFTER COMPLETE MESOCOLIC EXCISION FOR COLON CARCINOMA

目的探讨结肠癌完整系膜切除(complete mesocolic excision,CME)术后腹腔乳糜漏的病因、诊治及预防。方法对641例行结肠癌CME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(左半结肠与右半结肠)乳糜漏的发生率。结果 24例患者(3.7%)术后发生乳糜漏,开腹组与腹腔镜组的发生率分别为3.0%(9/296)和4.3%(15/345),差异无统计学意义(P>0.05);右半结肠CME术后腹腔乳糜漏发生率为7.9%(17/215),左半结肠CME术后乳糜漏发生率为1.6%(7/426),差异有统计学意义(P<0.05)。23例患者经积极非手术治疗(禁食、肠外营养、静脉使用生长抑素、抗感染治疗和延迟拔除腹腔引流管)均获治愈,1例行腹腔淋巴管漏口结扎术并局部使用医用OB胶治愈,无复发及死亡病例。结论结肠癌CME术开腹与腹腔镜在预防腹腔乳糜漏方面差异无统计学意义,右半结肠CME术式是腹腔乳糜漏的高危因素,术后腹腔乳糜漏经积极非手术治疗有效。

Objective To summarize the etiology, treatment, and preventive experience of the chylous fistula after complete mesocolic excision（CME） for colon carcinoma. Methods The clinical data of 641 cases of chylous fistula after CME for colon carcinoma 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） were compared. Results Chyloous fistula occurred in 24 patients （3.7%）, including 3.0% （9/296） in the laparotomy group and 4.3% （ 15/345 ） in the laparoscopy group, and there was no statistical significance （P 〉 0.05 ）. The incidence of ehylous fistula in CME for right colon carcinoma was 7.9% （ 17/215 ） , while the incidence of the chylous fistula in CME for left colon carcinoma was 1.6% （7/426） , and there was statistical significance （P 〈 0, 05 ）. Twenty-three patients received conservative treatment （ abrosia, total parenteral nutrition, somatostatin infusion, anti-infection, delaying removing drainage tubes） were successfully cured, and one patient received re-operation. No patients had recurrence and death. Conclusion There is no statistical significance in the incidence of chylous fistula between laparotomv groul3 and lalaaroscoov arouD. CME for right colon carcinoma is a high risk factor for chyle leak. Conservative treatment is effective in early stage of chyle leak after CME for colon carcinoma.