Ilhan Enver, Demir Uygar, Alemdar Ali, Ureyen Orhan, Eryavuz Yavuz, Mihmanli Mehmet
1 Department of General Surgery, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey ; 2 Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey ; 3 Department of General Surgery, Okmeydani Training and Research Hospital, Istanbul, Turkey.
J Gastrointest Oncol. 2016 Jun;7(3):420-5. doi: 10.21037/jgo.2016.02.03.
This study aimed to propose treatment strategies for high-output chylous ascites (CA) developed after gastric cancer surgery.
The data of patients with CA after gastric cancer surgery in three high volume Training and Research Hospitals between 2005 and 2015 were retrospectively evaluated.
Nine patients out of 436 gastrectomies were detected with CA. The mean amount of daily fistula output was 939 mL. Treatment consisted of cessation of oral feeding, total parenteral nutrition (TPN), somatostatin analogs administration, clamping and/or removal of the drainage tube, diuretic administration and diet therapy with medium-chain triglycerides (MCTs) alone or in combination. The mean fistula closure time and length of hospital stay were 23 and 24 days respectively. Hemopneumothorax developed during right subclavian vein catheterisation for TPN implementation in one patient. There was no mortality.
Combined cessation of oral feeding and TPN are usually used for treatment of CA as first-line treatment. However, TPN is no harmless. Although our data are limited they do allow us to conclude that diet with MCT's may use for medical treatment of CA as first-line.
本研究旨在提出胃癌手术后发生的高输出量乳糜性腹水（CA）的治疗策略。
回顾性评估2005年至2015年期间三家大型培训和研究医院中胃癌手术后发生CA的患者数据。
436例胃切除术中9例被检测出患有CA。每日瘘液平均排出量为939毫升。治疗包括停止经口喂养、全胃肠外营养（TPN）、给予生长抑素类似物、夹闭和/或拔除引流管、给予利尿剂以及单独或联合使用中链甘油三酯（MCTs）进行饮食治疗。平均瘘口闭合时间和住院时间分别为23天和24天。1例患者在实施TPN的右锁骨下静脉置管过程中发生血气胸。无死亡病例。
停止经口喂养和TPN联合通常作为CA的一线治疗方法。然而，TPN并非毫无风险（此处原英文“no harmless”表述有误，推测应是“not harmless”，翻译为并非毫无风险）。尽管我们的数据有限，但确实可以得出结论，含MCTs的饮食可作为CA的一线药物治疗方法。
