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目的分析和探讨胃癌根治术后乳糜漏发生发展的规律及治疗预防方法。方法前瞻性地对161例胃癌患者行 D2～D4胃癌根治术,术中常规每一例患者于腹腔动脉及腹主动脉膈肌角附近放置双套管引流一根。术后密切观察引流管中乳糜液的情况,行乳糜液的微生物涂片和培养,对有感染的乳糜液进行抗感染治疗。观察乳糜漏的发生发展规律,明确引流管拔除的时机。结果161例进行 D2～D4胃癌根治术患者,19例发生乳糜漏,引流量小于250 ml/24 h 8例,250～500 ml/24h 7例,500～1500 ml/24 h 4例。8例引流液中有大量白色假丝酵母菌生长,其中5例合并细菌生长。乳糜漏均于术后10～90 d 痊愈。乳糜漏的引流管在引流量几乎为零;感染乳糜液治疗后乳糜液为乳白色,无菌生长;B 超腹腔无积液,患者一般情况良好,无感染表现,即可拔管。结论胃癌 D2～D4术后发生乳糜漏后,如及时发现,充分引流,合并真菌或细菌感染时抗感染治疗及局部持续冲洗,乳糜漏可痊愈。
Objective To analyze and discuss the rule of occurrence and development of chylous leakage after radical operation of gastric cancer and its prevention and treatment. Methods A total of 161 patients with gastric cancer underwent radical resection of D2 ~ D4 gastric cancer by prospectively. In the routine operation, a double cannula was placed around the celiac artery and the abdominal aorta. Close observation of chylous drainage in the drainage tube was performed after surgery. Microbial smear and culture of chylous liquid were performed to treat infected chylous fluid. Observe the occurrence and development of chyle leakage rule, clear drainage tube removal timing. Results 161 patients underwent D2 ~ D4 radical gastrectomy, 19 cases had chylothorax, 8 cases of drainage less than 250 ml / 24 h, 7 cases of 250 ~ 500 ml / 24h and 4 cases of 500 ~ 1500 ml / 24 h. 8 cases of drainage fluid in a large number of Candida albicans growth, of which 5 cases of bacterial growth. Chylous leakage were recovered after 10 ~ 90 d. Drainage of chylous drain in the draining volume is almost zero; chylous fluid infection after the treatment of chylous milky white, sterile growth; B super-abdominal no effusion, the patient generally good, no infection, you can extubation. Conclusions After chylothoracic resection of D2 ~ D4 gastric cancer, timely and thorough drainage, combined with fungal or bacterial infection, anti-infection treatment and local continuous rinsing, chylothorax can be cured.