中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2012年
4期
328-331
,共4页
孙艳武%池畔%林惠铭%卢星榕%黄颖%徐宗斌%黄胜辉
孫豔武%池畔%林惠銘%盧星榕%黃穎%徐宗斌%黃勝輝
손염무%지반%림혜명%로성용%황영%서종빈%황성휘
结肠肿瘤%完整结肠系膜切除术%手术并发症%乳糜漏
結腸腫瘤%完整結腸繫膜切除術%手術併髮癥%乳糜漏
결장종류%완정결장계막절제술%수술병발증%유미루
Colonic neoplasms%Complete mesocolic excision%Postoperative complication%Chyle leak
目的 探讨结肠癌完整结肠系膜切除(CME)术后乳糜漏的发生率、影响因素及防治措施.方法 收集2000年9月至2011年9月间福建医科大学附属协和医院结直肠外科同一组医师连续实施的592例结肠癌CME患者的临床资料.结果 592例结肠癌CME术后共发生乳糜漏46例(7.7％),CME右半结肠切除术后乳糜漏发生率为13.3％(30/226),显著高于CME左半结肠切除术后的4.4％(16/366) (P=0.000).单因素同归分析结果显示,肿瘤大小(P＜0.05)、肿瘤部位(P＜0.01)及清扫淋巴结数目(P＜0.01)与CME术后乳糜漏有关;多因素回归分析结果显示,肿瘤部位和清扫淋巴结数目是CME术后发生乳糜漏的独立危险因素(P＜0.05).结论 肿瘤部位和清扫淋巴结数目是结肠癌CME术后乳糜漏的独立危险因素.当患者术后开始进食后腹腔引流量由少而突然增加时,应积极进行乳糜试验检查,以便早期明确诊断并及时治疗.
目的 探討結腸癌完整結腸繫膜切除(CME)術後乳糜漏的髮生率、影響因素及防治措施.方法 收集2000年9月至2011年9月間福建醫科大學附屬協和醫院結直腸外科同一組醫師連續實施的592例結腸癌CME患者的臨床資料.結果 592例結腸癌CME術後共髮生乳糜漏46例(7.7％),CME右半結腸切除術後乳糜漏髮生率為13.3％(30/226),顯著高于CME左半結腸切除術後的4.4％(16/366) (P=0.000).單因素同歸分析結果顯示,腫瘤大小(P＜0.05)、腫瘤部位(P＜0.01)及清掃淋巴結數目(P＜0.01)與CME術後乳糜漏有關;多因素迴歸分析結果顯示,腫瘤部位和清掃淋巴結數目是CME術後髮生乳糜漏的獨立危險因素(P＜0.05).結論 腫瘤部位和清掃淋巴結數目是結腸癌CME術後乳糜漏的獨立危險因素.噹患者術後開始進食後腹腔引流量由少而突然增加時,應積極進行乳糜試驗檢查,以便早期明確診斷併及時治療.
목적 탐토결장암완정결장계막절제(CME)술후유미루적발생솔、영향인소급방치조시.방법 수집2000년9월지2011년9월간복건의과대학부속협화의원결직장외과동일조의사련속실시적592례결장암CME환자적림상자료.결과 592례결장암CME술후공발생유미루46례(7.7％),CME우반결장절제술후유미루발생솔위13.3％(30/226),현저고우CME좌반결장절제술후적4.4％(16/366) (P=0.000).단인소동귀분석결과현시,종류대소(P＜0.05)、종류부위(P＜0.01)급청소림파결수목(P＜0.01)여CME술후유미루유관;다인소회귀분석결과현시,종류부위화청소림파결수목시CME술후발생유미루적독립위험인소(P＜0.05).결론 종류부위화청소림파결수목시결장암CME술후유미루적독립위험인소.당환자술후개시진식후복강인류량유소이돌연증가시,응적겁진행유미시험검사,이편조기명학진단병급시치료.
Objective To investigate the incidence,risk factors and preventative methods associated with chyle leak following complete mesocolic excision (CME) for colon cancer.Methods Clincial data of 592 patients with colon cancer undergoing CME in the department of Colorectal Surgery in the Fujian Medical University Union Hosptital from September 2000 to September 2011 were analyzed retrospectively.Results Chyle leak occurred in 46 patients (7.7％).The incidence of postoperative chyle leak following right CME hemicolectomy was 13.3％(30/226),significantly higher than that after left CME hemicolectomy (4.4％).On univariate analysis,chyle leak following CME was associated with tumor size (P＜0.05),tumor location (P＜0.01),and lymph nodes harvested (P＜0.01).Mnhivariate logistic regression revealed that tumor location and lymph nodes harvested were independent risk factors associated with chyle leak following CME (P＜0.05).Conclusions Tumor location and lymph nodes harvested are independent risk factors for chyle leak following complete mesocolic excision for colon cancer.When the drainage output suddenly increases after oral intake resumption,the chyle test of ascitic fuild should be performed for early diagnosis and prompt management.
