Yamada Takanobu, Jin Yasuyuki, Hasuo Kimiatsu, Maezawa Yukio, Kumazu Yuta, Rino Yasushi, Masuda Munetaka
Department of Surgery, Hadano Red Cross Hospital, 1-1 Tatenodai, Hadano, Kanagawa 257-0017, Japan; Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
Int J Surg Case Rep. 2013;4(12):1173-5. doi: 10.1016/j.ijscr.2013.10.006. Epub 2013 Oct 29.
Chylorrhea is a form of lymphorrhea involving digested lipid products absorbed in the small intestine. Here we report a rare case of chylorrhea after laparoscopy-assisted distal gastrectomy (LADG) with D1+ dissection that resolved following administration of a low-fat diet.
A 35-year-old woman with early gastric cancer underwent LADG with D1+ dissection, and on postoperative day 4, the drain output increased and the fluid with a high triglyceride level (740mg/dL) changed from clear to milky. On postoperative day 6, oral intake of a low-fat diet was initiated after a 2-day fast, and the daily drain output decreased from postoperative day 9. The drain tube was withdrawn on postoperative day 15, and the patient was discharged on postoperative day 17.
D1+ dissection does not typically cause injury to the lymphatic trunks, cisterna chyli, or thoracic duct. The maximum output of chylous ascites was minimal, and thus, we assumed that chylorrhea occurred from slightly injured lymphatics with anatomical variation.
Chylorrhea after LADG with D1+ dissection is very rare. The fasting of our case followed by a low-fat diet without TPN would be an effective therapy. As a result, our case recovered favorably without further therapy.
乳糜漏是一种淋巴漏，涉及在小肠吸收的消化脂质产物。在此，我们报告一例罕见的腹腔镜辅助远端胃切除术（LADG）加D1+清扫术后发生乳糜漏的病例，通过给予低脂饮食后得以缓解。
一名35岁的早期胃癌女性接受了LADG加D1+清扫术，术后第4天，引流液量增加，甘油三酯水平高（740mg/dL）的液体从清亮变为乳白色。术后第6天，在禁食2天后开始口服低脂饮食，术后第9天起每日引流液量减少。术后第15天拔除引流管，患者于术后第17天出院。
D1+清扫术通常不会损伤淋巴管主干、乳糜池或胸导管。乳糜腹水的最大引流量极少，因此，我们推测乳糜漏是由于淋巴管轻微损伤伴解剖变异所致。
LADG加D1+清扫术后发生乳糜漏非常罕见。我们病例中先禁食然后给予低脂饮食而非全胃肠外营养（TPN）是一种有效的治疗方法。结果，我们的病例未经进一步治疗即顺利康复。
