难治性乳糜腹术中精准定位新方向的探索研究

Application of novel positioning technology for refractory chylous ascites

目的探讨使用纳米碳示踪剂来有效精准定位乳糜腹漏口的新方法。方法根据纳米微粒子的大小以及生物学的稳定特征,将其应用于乳糜腹的手术治疗中。术中于肠系膜处分点注射纳米碳示踪剂明确乳糜漏口的位置,寻找到确切的乳糜漏口后结扎,观察是否仍有乳糜漏。结果通过使用纳米碳示踪剂后精确定位到乳糜漏口位置,直视下明确后结扎乳糜漏口,反复多点注射纳米碳示踪剂后未发现其余部位乳糜漏口的存在,放置腹腔引流管再未出现乳糜腹。术后第四天开始喂养(纽太特),观察2个月后更换为正常奶粉喂养,再观察半个月无复发迹象。结论使用纳米碳示踪剂可准确定位乳糜腹漏口位置,多点注射提高了乳糜漏口检出率,起到了精准治疗的重要作用,纳米碳示踪剂应用于需手术治疗的乳糜腹中安全有效,对乳糜腹(胸)的治疗具有重要的价值。

Objective The therapeutic key of chylous ascites is to localize the exact leakage site.At present,all localizing methods and surgical approaches have certain limitations so that it is imperative to explore an ideal way of more effectively and accurately locating the leakage site.Methods Application of nanoparticle was pioneered on the basis of its sizes and biological characteristics.Nanoparticle suspension was injected into mesentery for detecting the leakage site for ligating.Results The leakage site was accurately located by using nanoparticles and ligating under a direct vision.After multiple injections and placing abdominal drainage tube,no other leakage was detected in abdominal cavity.Enteral feeding with milk (NUTRICIA) at Day 4 postoperation was switched to normal milk powder after 2-month observations.There was no sign of recurrence within half a month.Conclusions Nanoparticles can locate the position of chyle accurately and its accuracy may be improved by multi-point injection.It plays an important role in precise treatment.Using nanoparticle tracer is both safe and effective for chylous ascites or chylothorax.