胰腺术后乳糜漏诊治研究进展

Progress in diagnosis and treatment of chylous leakage following pancreatic resection

与胰腺术后其他并发症相比,乳糜漏发生率较低,但长期、大量乳糜漏可引起营养不良、免疫抑制、腹腔感染等严重并发症。胰腺术后乳糜漏的发生与术中淋巴结清扫所致的乳糜池或淋巴管损伤、术后早期肠内营养等有关。因其临床特征不明显,诊断主要依靠引流液成分分析,现行诊断标准普遍采用国际胰腺外科研究小组专家共识标准,但该标准仅适用于孤立性乳糜漏,临床适用价值仍有争议。引流液成分分析和腹部CT检查是首选诊断方法,而淋巴管造影不仅可以明确渗漏部位,还具有治疗价值。乳糜漏的治疗通常采取阶梯式治疗策略,通畅引流、调整饮食、生长抑素药物等保守治疗可使多数患者痊愈,手术治疗较少使用,手术效果有待进一步考证。术中妥善结扎淋巴管,优化围手术期的管理措施,针对不同患者采用个性化的治疗方案,可有效预防术后乳糜漏,促进患者康复。

Compared with other postoperative complications following pancreatic resection,chylous leakage is rare in clinical,which could lead to serious morbidity,including malnutrition,immunosuppression and abdominal infection.The main risk factors for chylous leakage after pancreatic resection are the injury of cisterna chyli or lymphatic vessels caused by intraoperative lymph node dissection and early enteral nutrition.The clinical features of chylous leakage are not specific,and the diagnosis mainly depends on the composition analysis of the drainage fluid.The diagnostic criteria generally adopt the expert consensus of the international Study Group on Pancreatic Surgery,but it is only applicable to isolated chylous leakage and there is still no widely accepted diagnostic criteria in most complex cases.Abdominal fluid analysis and abdominal CT scan are the most applied diagnostic methods for chylous leakage after pancreatic resection,while lymphangiography can not only identify the site of leakage,but also has therapeutic value.For its treatment,the"step-up"treatment strategy is typically applied in most patients.Conservative treatments,including drainage,proper diet and applying octreotide,can benefit most patients.Surgical treatment is not commonly used,and its therapeutic value needs to be further verified.Optimizing perioperative management measures and personalized treatment strategies for different patients can effectively prevent postoperative chylous leakage and maximize the clinical benefits of patients who received pancreatic resection.