胰十二指肠切除术后并发乳糜瘘的诊治体会  

Diagnosis and treatment of chylous fistula after pancreaticoduodenectomy

作　　者：曹学峰[1,2] 管清海[1,2] 王西秀[1,2] 林绪涛[1,2] 欧琨[1,2] 

机构地区：[1]滨州医学院附属医院肝胆外科 [2]滨州医学院附属医院临床营养支持中心,山东省滨州市256603

出　　处：《世界华人消化杂志》2014年第30期4654-4657,共4页World Chinese Journal of Digestology

摘　　要：目的:探讨胰十二指肠切除术(pancreaticoduod enectomy,PD)后并发乳糜瘘的诊断与治疗.方法:将滨州医学院附属医院肝胆外科2012-01/2014-06行PD并发乳糜瘘的患者临床资料进行回顾性分析,分析探讨PD术后并发乳糜瘘的原因、诊断与定位、预防与治疗.结果:PD术后并发乳糜瘘发生率约为3.85%,P D术后乳糜瘘的发生与术前营养不良、术中淋巴结清扫及术后早期肠内营养可能有关,PD术后并发乳糜瘘患者经禁饮食、腹腔通畅引流、调整肠内外营养支持结构及静脉应用奥曲肽治疗后均瘘口愈合、痊愈出院.结论:PD术后并发乳糜瘘有多方面的原因,提高对PD术后并发乳糜瘘的认识、熟悉PD术后并发乳糜瘘的原因及预防措施、掌握PD术后并发乳糜瘘的处理原则及方法具有重要临床意义.AIM： To summarize our experiences in the diagnosis and treatment of chylous fistula after pancreaticoduodenectomy（PD）. METHODS： The clinical data for patients with chylous fistula after PD treated from January 2012 to June 2014 at our hospital were analyzed retrospectively. The causes, diagnosis, localization, prevention and treatment of chylous fistula after PD were explored. RESULTS： The incidence of chylous fistula after PD was 3.85%, and the causes of chylous fistula after PD might include preoperative malnutrition, intraoperative lymph node dissection and postoperative early enteralnutrition. Patients with chylous fistula after PD were cured by fasting, abdominal cavity drainage, adjustment of enteral and parenteral nutritional support structure and intravenous octreotide treatment. CONCLUSION： Multiple factors might cause chylous fistula after PD, and it is of important clinical significance to understand the causes, preventive measures, treatment principles and methods.

关 键 词：胰十二指肠切除术 乳糜瘘 术后并发症 

分 类 号：R657.5[医药卫生—外科学]