CAJ | 학술논문

目的本文探讨小儿门静脉海绵样变术后并发乳糜腹水的发病原因,预防措施及治疗方法.方法回顾性分析本院5年间收治因门静脉海绵样变门脉高压而反复上消化道出血患儿9例,均行手术治疗,术后4例出现乳糜腹,其中2例发生于脾脏切除加脾肾静脉分流术后,1例发生于肠系膜上静脉下腔静脉分流术后,1例发生于Warren术后.结果 4例乳糜腹水患儿有3例经过禁食及TPN等保守治疗后在术后1～4周乳糜腹水消失,1例患儿经过4周保守治疗后每天仍有2000 ml左右的乳糜腹水,在术后4周行腹腔大隐静脉转流术,术后1周乳糜腹水消失.随访1～6年,均无复发.结论门静脉海绵样变术后并发乳糜腹水的主要原因为术中损伤淋巴管或乳糜池,保守治疗有效,必要时可手术治疗.
목적 본문탐토소인문정맥해면양변술후병발유미복수적발병원인,예방조시급치료방법.방법 회고성분석본원5년간수치인문정맥해면양변문맥고압이반복상소화도출혈환인9례,균행수술치료,술후4례출현유미복,기중2례발생우비장절제가비신정맥분류술후,1례발생우장계막상정맥하강정맥분류술후,1례발생우Warren술후.결과 4례유미복수환인유3례경과금식급TPN등보수치료후재술후1～4주유미복수소실,1례환인경과4주보수치료후매천잉유2000 ml좌우적유미복수,재술후4주행복강대은정맥전류술,술후1주유미복수소실.수방1～6년,균무복발.결론 문정맥해면양변술후병발유미복수적주요원인위술중손상림파관혹유미지,보수치료유효,필요시가수술치료.
Objective To analyze the cause,prevention and therapy of postoperative complicated chylous ascites of cavernous transformation of portal vein in children.Methods Between Jan.2001 and Apr.1 2006.9 patients(male 5,female 4)who had recurrent upper gastrointestinal hemorrhage caused by cavernous degeneration of portal vein were operated and analyzed retrospectively.Their age ranged from 2yr7mon to 12yr2mon with an average of 7yr3mon.Four patients had complicated postoperative chylous ascites.Of them,2 cases were performed on splenectomy and splenorenal shunt,1 was received side-to-side mesocaval shunt and 1 had distal splenorenal shunt.Results Three of the 4 patients were cured after short-term fasting and total parental nutrition(TPN)administrated for 1-4 weeks.One case had accumulating ehylus aboUt 2000 ml daily after 4 weeks of conservative treatment,and the chylus was discharged one week after a peritoneo-saphenous shunt. An patients were followed-up from 1 year to 6 years without recurrence.Conclusions The cause of postoperative complicated chylous ascites of cavernous transformation of portal vein in children is the damaging of lymphatic vessels and the chylocyst during operation.Conservative therapy is effective,whereas an operation is chosen if necessary.