胰十二指肠切除术后乳糜漏的成因分析和治疗手段

目的 研究分析胰十二指肠切除术后乳糜漏的成因,并总结预防和诊治经验.方法 回顾性研究2010年1月至2012年12月在我科接受胰十二指肠切除术（包括保留幽门的胰十二指肠切除术）的患者381例,其中23例术后确诊发生乳糜漏,发生率约为6.04％.结果 23例发生乳糜漏的患者中,术后病理回报胰腺恶性肿瘤21例,胰腺良性肿瘤2例.发生乳糜漏的平均时间为术后第6天（第5天至8天）,每日引流量约为260～ 450 mL,平均355 mL.全部患者均经保守治疗痊愈出院.结论 胰十二指肠切除术后乳糜漏多发生在恶性肿瘤根治性切除术后,手术过程中对淋巴管道和钩突系膜的物理结扎或缝扎效果要优于应用超声刀、Ligasure等电外科技术.术后乳糜漏的治疗应以保守治疗为主,密切观察患者的引流量,适时调整治疗策略.

Analysis of cause and therapy of chylous leakage after pancreaticoduodenectomy

Objective To study and analyze the cause and the experience of prevention and treatment of chylous leakage after pancreaticoduodenectomy （PD）. Methods Retrospective study was done in 381 patients underwent pancreaticoduodenectomy in our department from Jan. 2010 to Dec. 2012 （including the pyloruspreserving pancreaticoduodenectomy）, 23 cases were diagnosed as chylous leakage, accounting for 6.04% of the total. Results In 23 patients with chylous leakage, 21 cases of postoperative pathology were reported malignant tumor of the pancreas, and 2 cases of benign tumors of the pancreas. The average time of chylous leakage was 6 d （5-8 d） after surgery, the daily flux was 260-450 mL （average 355 mL）, all patients were cured by conservative treatment. Conclusion Chylous leakage after pancreaticoduodenectomy often occurs in cancer radical resection, in the operation process, the physical effects of lymphatic vessels ligation and uncinate process of membrane are better than the application of ultrasonic scalpel and Ligasure electric surgical techniques. Treatment of chylous leakage after surgery should be based on conservative treatment, the volume of drainage should be closely observated of patients and the treatment strategy should be timely adjusted.