乳腺癌腹腔转移术后乳糜腹水的营养支持治疗

Therapy of chylous ascites after laparotomy for abdominal metastasis of breast cancer

目的 :探讨乳腺癌腹腔转移病人腹部手术后乳糜腹水的非手术治疗。 方法 :1例乳腺癌根治术后腹腔转移的病人施行剖腹探查、大网膜切除、胃空肠吻合、空肠造口术 ,术后第 1 1天达到全肠内营养时发现腹腔引流液变成乳白色 ,乳糜试验阳性 ,诊断为乳糜漏 ,遂停止肠内营养 (EN) ,给予全肠外营养支持 1周 ,随后开始经空肠造口给予自行配制的不含脂肪的EN制剂 ,术后 1个半月开始口服低脂饮食。 结果 :病人在停止EN之后第 2天 ,引流液的乳糜试验就转为阴性 ,三酰甘油浓度显著下降 ,引流量迅速减少。开始应用不含脂肪的EN支持后 ,引流液始终为淡黄色澄清液体 ,引流量逐渐减少 ,直至术后第 30天拔除引流管。 结论 :对于因恶性肿瘤腹腔转移施行腹部手术后发生乳糜腹水的病人 ,非手术治疗可能是最佳方法。及时诊断并尽早给予合理的营养支持治疗 。

Objectives:To observe the effectivenessof the nutritional therapy in postoperative chylous ascites caused by laparotomy for abdominal metastasis of breast cancer. Methods:Omentectomy, gastrojejunostomy and jejunostomy were performed in an advanced breast cancer patient for abdominal metastasis. Postoperative tube feeding with Ensure was used and chylous ascites appeared in day 11 after operation. Then the enteral nutrition was substituted by total parenteral nutrition for a week, followed by a fat free enteral nutrion formula (fat free soya bean protein powder and sucrose) and at last an oral low fat diet. Results:Two days after cessation of tube feeding of Eusure, the Sudan Ⅲ stain of ascites became negative, accompanied with decrease of the concentration of triglyceride and drainage volume. Such trend had been kept during the fat free enteral nutrition and up to 30 days after laparotomy,and then the drain tube was withdrawn. Conclusions:For chylous ascites caused by abdominal operation for metastatic cancer, non operative therapy may be the most practical method. Early detection and proper nutritional therapy may get a dramatic result in a short interval.