结直肠肿瘤根治术后腹腔乳糜漏的诊治

目的 总结结直肠肿瘤根治术后腹腔乳糜漏的诊治及预防经验.方法 比较1259例不同术式（开腹与腹腔镜）、不同部位（右半、左半结肠与直肠）结直肠肿瘤根治术后腹腔乳糜漏的发生率.结果 本组46例患者（3.6%）术后发生腹腔乳糜漏,开腹组与腹腔镜组的发生率分别为3.2%（18/570）和4.1%（28/689）,差异无统计学意义（P＞0.05） 右半结肠根治术后腹腔乳糜漏的发生率为9.6%（16/167）,显著高于左半结肠的2.6%（7/268）和直肠的2.8%（23/824）（P＜0.05）.45例患者经保守治疗（治疗措施包括禁食、肠外营养、静脉使用生长抑素和延缓拔除腹腔引流管）治愈,1例经行腹腔淋巴管漏口结扎术并局部喷洒医用胶治愈,无死亡病例.结论 根治性右半结肠切除是术后发生乳糜漏的高危因素 术后腹腔乳糜漏保守治疗有效.

Treatment of chyle leak following radical resection for colorectal cancer

Objective To investigate the treatment of chyle leak following radical resection for colorectal cancer.Methods The incidence of chyle leak was compared between the different surgical approaches (open vs.laparoscopic) as well as different tumor locations (right,left colon or rectum) in 1259 patients undergoing radical resection for colorectal cancer.Results Overall incidence of chyle leak was 3.6% (46/1259) after surgery.Forty-five patients were successfully managed by conservative treatment and one patient required re-operation.No patients died.The incidence of chyle leak was not significantly different between the open (3.2%,18/570) and laparoscopic (4.1%,28/689) groups (P＞0.05).However,right colectomy was associated with a significantly higher rate of chyle leak (9.6%,16/167) as compared to left colectomy (2.6%,7/268) and anterior resection(2.8%,23/824)(P＜0.05).Conclusions Conservative treatment is effective in early stage of chyle leak after radical resection for colorectal cancer.Right colectomy is associated with higher risk for chyle leak.