Scaletta Giuseppe, Quagliozzi Lorena, Cianci Stefano, Vargiu Virginia, Mele Maria Cristina, Scambia Giovanni, Fagotti Anna
Division of Gynecologic Oncology, Department of Women's and Children's Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Department of Gastroenterology, Metabolic-endocrine and Nefro-urologic Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Updates Surg. 2019 Dec;71(4):729-734. doi: 10.1007/s13304-019-00656-x. Epub 2019 Apr 20.
Postoperative chylous ascites is a rare complication from operative trauma to the cisterna chyli or lymphatic vessels in the retroperitoneum. In the present study, we aimed to identify the incidence of postoperative chylous ascites in patients treated for ovarian cancer and to describe its management. We retrospectively reviewed all patients submitted to surgery for ovarian cancer at our Institution from October 2016 to November 2018. We analyzed the clinicopathological features, including the primary tumor histology, stage, grade, surgical procedure, median number of harvested pelvic and para-aortic lymph nodes. We described our experience in the diagnosis and management of chylous ascites. Five hundred and forty-six patients were submitted to surgery for ovarian cancer and 298 patients received pelvic and/or para-aortic lymphadenectomy. Chylous ascites occurred in 8 patients with an incidence of 1.4% in the overall population and a 2.68% among patients receiving lymphadenectomy. All patients received total parenteral nutrition (TPN) with Olimel N4E 2000 mL (Baxter) and somatostatin therapy with 0.2 mL per 3 times/day for a median of 9 days (range 7-11). Median hospital stay was 15 days (range 7-16). All patients were successfully managed conservatively and none required surgical correction. Conservative management of chylous ascites with TPN, somatostatin and paracentisis is feasible and effective. These data should be confirmed by prospective multicentric studies.
术后乳糜性腹水是一种因手术创伤累及乳糜池或腹膜后淋巴管而导致的罕见并发症。在本研究中，我们旨在确定接受卵巢癌治疗的患者术后乳糜性腹水的发生率，并描述其治疗方法。我们回顾性分析了2016年10月至2018年11月在我院接受卵巢癌手术的所有患者。我们分析了临床病理特征，包括原发性肿瘤组织学、分期、分级、手术方式、盆腔及腹主动脉旁淋巴结清扫的中位数。我们描述了我们在乳糜性腹水诊断和治疗方面的经验。546例患者接受了卵巢癌手术，其中298例患者接受了盆腔和/或腹主动脉旁淋巴结清扫术。8例患者发生乳糜性腹水，在总体人群中的发生率为1.4%，在接受淋巴结清扫术的患者中为2.68%。所有患者均接受了用Olimel N4E 2000 mL（百特公司）进行的全胃肠外营养（TPN）以及用0.2 mL每3次/天进行的生长抑素治疗，中位治疗时间为9天（范围7 - 11天）。中位住院时间为15天（范围7 - 16天）。所有患者均通过保守治疗成功治愈，无一例需要手术矫正。用TPN、生长抑素和腹腔穿刺术对乳糜性腹水进行保守治疗是可行且有效的。这些数据应通过前瞻性多中心研究加以证实。
