Haan James M, Montgomery Stephanie, Novosel Timothy J, Stein Deborah M, Scalea Thomas M
University of Maryland, R Adams Cowley Shock Trauma Center, Baltimore, Maryland 21201, USA.
Am Surg. 2007 Aug;73(8):811-3.
The objective of this study was to evaluate incidence of chylous injury in blunt trauma using a retrospective chart review. We present two patients who sustained chyle duct injury after blunt trauma. The first patient is a pedestrian struck by car. Abdominal CT scan revealed duodenal thickening and a moderate amount of paraduodenal fluid, which prompted surgical exploration. At laparotomy, the patient was found to have a disruption of his lymphatics at the level of the inferior vena cava (IVC) without duodenal injury treated with hemoclips, fibrin sealant and elemental gastrojejunal feeds. The second patient was involved in a high speed motor vehicle collision (MVC) resulting in transection of the mesentery of the transverse colon. Disrupted lacteals were treated intra-operatively with hemoclips and fibrin sealant decreasing the lymph leak. In both cases, the leak completely resolved with use of tube feedings with medium chain triglycerides. On literature review, six prior patients with spontaneous chylous retroperitoneum were described undergoing similar operative management. Chylous leakage due to blunt trauma is a rare finding. Mechanism of injury includes hyperextension or flexion resulting in stretching and shearing of the tethered lymphatics. Open ligation or clipping of the injured ducts seems effective. Tube feeds with medium chain triglycerides may enhance efficacy of operative treatment.
本研究的目的是通过回顾性病历审查来评估钝性创伤中乳糜损伤的发生率。我们报告了两名钝性创伤后发生乳糜管损伤的患者。首例患者是一名被汽车撞倒的行人。腹部CT扫描显示十二指肠增厚及十二指肠旁中等量液体，这促使进行手术探查。剖腹手术时，发现患者在下腔静脉水平淋巴管破裂，无十二指肠损伤，采用血管夹、纤维蛋白封闭剂及要素型空肠造瘘喂养治疗。第二例患者发生高速机动车碰撞，导致横结肠系膜横断。术中对破裂的乳糜管采用血管夹和纤维蛋白封闭剂治疗，减少了淋巴漏。在这两例中，通过使用含中链甘油三酯的管饲法，漏出完全消失。经文献检索，之前描述了6例自发性乳糜性腹膜后患者接受了类似的手术治疗。钝性创伤导致的乳糜漏是一种罕见的发现。损伤机制包括过度伸展或屈曲导致固定淋巴管的拉伸和剪切。对损伤的导管进行开放结扎或夹闭似乎有效。含中链甘油三酯的管饲法可能会提高手术治疗的效果。
