Department of General Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-0856, Japan.
Br J Surg. 2013 Mar;100(4):522-7. doi: 10.1002/bjs.9013. Epub 2013 Jan 3.
Postoperative chylous ascites following abdominal surgery is uncommon. It potentially induces malnutrition and immunodeficiency, contributing to increased mortality. In the field of hepatopancreatobiliary (HPB) surgery, no large studies have been conducted that focused on postoperative chylous ascites. The aim of this study was to determine the incidence, risk factors and management of chylous ascites following HPB surgery, with particular emphasis on pancreatic resection.
Consecutive patients who had HPB surgery between 2000 and 2011 at a single institution were reviewed retrospectively. Chyle leak was defined as 100 ml/day or more of milky, amylase-free peritoneal fluid with a triglyceride concentration of 110 mg/dl or above. Risk factors for chylous ascites associated with pancreatic resection and the clinical efficacy of octreotide in treating chylous ascites were evaluated.
Of 2002 consecutive patients who underwent HPB surgery during the study period, 21 (1·0 per cent) developed chylous ascites. Chylous ascites occurred relatively frequently in patients who had a pancreatic resection, such as pancreaticoduodenectomy (3·3 per cent) or distal pancreatectomy (3·8 per cent). Multivariable analysis revealed that manipulation of the para-aortic area (P < 0·001), retroperitoneal invasion (P = 0·031) and early enteral feeding after operation (P < 0·001) were independent risk factors for chylous ascites following pancreatic resection. Octreotide treatment decreased drainage output of chylous ascites on day 1 after initiation of treatment (P = 0·002).
Chylous ascites is a rare complication following HPB surgery. It is more common after pancreatic resection. Treatment with octreotide combined with total parenteral nutrition is recommended.
腹部手术后乳糜性腹水并不常见，但可能会导致营养不良和免疫功能缺陷，从而增加死亡率。在肝胆胰外科领域，尚未有大型研究专门针对肝胆胰手术后乳糜性腹水。本研究旨在确定肝胆胰手术后乳糜性腹水的发生率、危险因素和处理方法，尤其关注胰腺切除术。
回顾性分析 2000 年至 2011 年在一家机构接受肝胆胰手术的连续患者。乳糜漏定义为每天 100ml 或以上的乳白色、无淀粉酶的腹腔积液，甘油三酯浓度为 110mg/dl 或以上。评估了与胰腺切除相关的乳糜性腹水的危险因素以及奥曲肽治疗乳糜性腹水的临床疗效。
在研究期间，2002 例连续接受肝胆胰手术的患者中，有 21 例（1.0%）发生乳糜性腹水。乳糜性腹水在接受胰腺切除术的患者中较为常见，如胰十二指肠切除术（3.3%）或胰体尾切除术（3.8%）。多变量分析显示，主动脉旁区域的操作（P<0.001）、腹膜后侵犯（P=0.031）和术后早期肠内喂养（P<0.001）是胰腺切除术后发生乳糜性腹水的独立危险因素。奥曲肽治疗可降低治疗后第 1 天乳糜性腹水的引流量（P=0.002）。
乳糜性腹水是肝胆胰手术后罕见的并发症，在胰腺切除术后更为常见。推荐使用奥曲肽联合全肠外营养治疗。
