儿童腹部实体肿瘤术后乳糜腹的处理

目的儿童腹部实体肿瘤手术后并发症的临床处理报告甚少，其发生率报告不一。本研究总结作者单位儿童腹部实体肿瘤手术后乳糜腹的发生情况以及处理经验。方法回顾性分析上海交通大学医学院附属新华医院小儿外科2003年6月至2010年6月收治的249例儿童腹部实体肿瘤患儿临床资料，其中11例发生乳糜腹（4．4％），男性5例，女性6例，年龄中位数为15个月（1个月至12岁）。结果本组术后乳糜腹的发生率为4．4％。11例术后合并乳糜腹患儿根据腹水实验室分析进行诊断，最早出现于术后半天，最大体积为1250mL／d，均予临床观察和保守治疗，分别于术后9—72d治愈，其中10例通过禁食、全肠道外营养（TPN）、腹腔引流或使用生长抑素治愈，1例经保守治疗未愈，在腹腔镜下结扎破裂的淋巴管获痊愈。结论儿童实体肿瘤术后乳糜腹的原因与医源性手术创伤有关，大部分可通过禁食、TPN、腹腔引流治愈。

Management to chylous ascite: complication after solid tumor resection in children.

Objective Postoperative chylous ascites is a rare complication of retroperitoneal and perito- neal surgery that has a considerable morbidity. We review the pathogenesis and management of chylous ascites following surgical treatment of solid tumor in children. Methods We identified 11 children with chylous asci- tes after surgical treatment of solid tumor between June 2003 and Jun 2010, in Xinhua Hospital, Shanghai Jiao- tong University, School of Medicine. Considering the whole 249 cases of solid abdominal tumor treated dur- ing this period, the incidence of chylous ascites after surgical treatment was 4.4%. Results The interval be- tween surgery and diagnosis of ascites ranged from 12 hours to 7days. They were successfully treated with con- servative measures, total parenteral nutrition, strict fasting, abdominal drainage, and injection of somatostatin. Condnsions Chylous ascites after surgical treatment of pediatric solid tumor is related to the surgical ablation of retroperitoneal lymph. Conservative treatment with total parenteral nutrition, strict fasting, and abdominal drainage will remedy the problem in the majority of children.