CAJ | 학술논문

目的探讨消化系统恶性肿瘤术后淋巴漏的治疗.方法回顾性分析2008年12月至2012年2月间中山大学孙逸仙纪念医院收治的19例消化系统恶性肿瘤术后出现淋巴漏的患者的临床资料.结果 19例患者淋巴漏均发生于术后2～4 d,均先采用早期禁食、肠外营养、24 h持续静滴生长抑素等保守治疗及腹腔引流管低负压吸引,其中8例引流液显著减少,经保守治疗6～10d治愈;10例引流液减少并稳定至200 ml/d左右,进行肠内营养,并每天使用泛影葡胺30 ml经引流管反复冲洗,12～24 d治愈;另1例患者经保守治疗1周后引流液无明显减少,且自觉腹胀明显,于术后第11天行再次开腹手术缝扎淋巴漏管裂口,术后第4天拔除腹腔引流管,治愈出院.结论消化系统恶性肿瘤术后淋巴漏经保守治疗大多数能治愈,生长抑素的使用和腹腔引流管局部处理为主要措施.对于保守治疗无效者应行手术治疗,以防止严重并发症的发生.
목적 탐토소화계통악성종류술후림파루적치료.방법 회고성분석2008년12월지2012년2월간중산대학손일선기념의원수치적19례소화계통악성종류술후출현림파루적환자적림상자료.결과 19례환자림파루균발생우술후2～4 d,균선채용조기금식、장외영양、24 h지속정적생장억소등보수치료급복강인류관저부압흡인,기중8례인류액현저감소,경보수치료6～10d치유;10례인류액감소병은정지200 ml/d좌우,진행장내영양,병매천사용범영포알30 ml경인류관반복충세,12～24 d치유;령1례환자경보수치료1주후인류액무명현감소,차자각복창명현,우술후제11천행재차개복수술봉찰림파루관렬구,술후제4천발제복강인류관,치유출원.결론 소화계통악성종류술후림파루경보수치료대다수능치유,생장억소적사용화복강인류관국부처리위주요조시.대우보수치료무효자응행수술치료,이방지엄중병발증적발생.
Objective To investigate the treatment of postoperative chyle leak after surgery for digestive malignancies.Methods From December 2008 to February 2012, in the Sun Yat-sen Memorial Hospital of Sun Yat-sen University,clinical data of 19 patients with chyle leak after digestive system cancer surgery were retrospective analyzed.Results Nineteen cases of chyle leak were all identified between the second and the fourth postoperative day and were all initially managed with conservative treatment including early fasting,parenteral nutrition (PN),24-hour continuous infusion of somatostatin,and low pressure suction drainage.Eight patients were treated successfully for 6 to 10 days with a significant reduction of the daily drainage volume.Ten patients had enteral nutrition(EN ) and their drain tubes were repeatedly washed with 30 ml of compound meglumine diatrizoate injection every day until the drainage volume decreased to 200 ml/day.The time to resolution of chyle leak in these ten patients ranged from 12 to 24 days.One patient had no significant decrease in fluid drainage and developed abdominal distension after one week of conservative treatment.Surgical closure of chyle leak was performed on the l1th postoperative day,abdominal cavity drainage tube was removed on the 4th postoperative day.The patient was discharged home in good condition. Conclusion Most postoperative chyle leak after surgery for digestive malignancies can be successfully managed with conservative treatment.Somatostatin and the drainage are the main therapeutic approaches.When chyle leak is not resolved with conservative treatment,surgical treatment should be considered to prevent serious complications.