Markham K M, Glover J L, Welsh R J, Lucas R J, Bendick P J
Department of Surgery, Williaim Beaumont Hospital, Royal Oak, Michigan 48703, USA.
Am Surg. 2000 Dec;66(12):1165-7.
Anecdotal reports support the use of octreotide in the treatment of traumatic thoracic duct injuries and chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of octreotide in treating thoracic duct transection in a canine model. Eight mongrel dogs (27.8+/-5.1 kg) were fed one pint of 10.5 per cent milkfat 2 hours before operation. Through a left supraclavicular neck incision, the thoracic duct was identified and transected, producing free flow of chyle. A quarter-inch drain was tunneled subcutaneously from the wound and attached to closed suction. After wound closure dogs were randomized to a control group (n = 4) receiving sham injections of saline subcutaneously three times per day, or a treatment group (n = 4) given 3 microg/kg octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output was measured each day, and on odd-numbered postoperative days the drainage was analyzed for cholesterol, triglycerides, albumin, and total protein. Fistula closure was defined as drainage <10 ml/24-hour period. Treated dogs achieved fistula closure significantly faster than controls: 3.5+/-1.3 days versus 7.8+/-1.0 days (P = 0.0037). Whereas equivalent amounts of drainage occurred on the day of surgery and on postoperative day one in both groups, by postoperative day 2 the treatment group had significantly less drainage over 24 hours: 63+/-69 ml versus 195+/-79 ml (P = 0.046); this significant difference persisted through postoperative day 5 when drainage began to decrease in the control group. No significant differences between groups were seen in levels of cholesterol, triglycerides, albumin, or protein in the drainage at any time point. We conclude that octreotide is effective in treating thoracic duct injury, leading to an early decrease in drainage and early fistula closure. The mechanism for this effect remains to be clarified.
轶事报道支持使用奥曲肽治疗创伤性胸导管损伤和乳糜胸，但尚无前瞻性研究证实其疗效。我们在犬模型中评估了奥曲肽治疗胸导管横断的效果。八只杂种犬（体重27.8±5.1千克）在手术前2小时喂食1品脱含10.5%乳脂肪的牛奶。通过左锁骨上颈部切口，识别并横断胸导管，使乳糜自由流出。将一根四分之一英寸的引流管经皮下从伤口穿出并连接至闭式引流。伤口闭合后，将犬随机分为对照组（n = 4），每天皮下注射三次生理盐水作为假注射，或治疗组（n = 4），每天给予3微克/千克奥曲肽三次。术后所有犬均喂食标准低脂（5 - 7%）粗脂肪饮食。每天测量引流量，术后奇数日对引流液进行胆固醇、甘油三酯、白蛋白和总蛋白分析。瘘管闭合定义为24小时引流量<10毫升。治疗组犬的瘘管闭合明显快于对照组：3.5±1.3天对7.8±1.0天（P = 0.0037）。两组在手术当天和术后第1天的引流量相当，但到术后第2天，治疗组24小时引流量明显减少：63±69毫升对195±79毫升（P = 0.046）；当对照组引流量开始减少时，这种显著差异持续到术后第5天。在任何时间点，两组引流液中胆固醇、甘油三酯、白蛋白或蛋白质水平均无显著差异。我们得出结论，奥曲肽对治疗胸导管损伤有效，可导致引流量早期减少和瘘管早期闭合。这种作用机制尚待阐明。
