Department of Digestive Surgery, Akershus University Hospital, Lørenskog, 1478, Norway.
Anatomy Sector, Teaching Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Langenbecks Arch Surg. 2020 Nov;405(7):1017-1024. doi: 10.1007/s00423-020-01938-4. Epub 2020 Jul 20.
We aim to find the incidence of chylous ascites in patients undergoing D3 extended mesenterectomy and evaluate if a routine fat-reduced diet (FRD) has a prophylactic effect.
Data from 138 patients included in a D3 extended mesenterectomy trial were collected prospectively. Surgical drains and biochemical testing of drain fluid were used to find the incidence of chylous ascites among the first 39 patients, and a prophylactic fat-reduced diet was then implemented in the next 99 patients as a prophylactic measure.
In the first 39 patients, we found that 16 (41.0%) developed chylous ascites. After the fat-reduced diet was implemented, 1 (1.0%) of 99 patients developed chylous ascites. Drain discharge was 150 vs. 80 mL daily, respectively, and a regression analysis shows the average leakage in the group with fat-reduced diet was 105 mL/day less than in the patients with no dietary restrictions (p < 0.001). There were no significant differences in the rate of other complications (Fisher exact test, one-tailed p = 0.8845), and although there was a tendency to a shorter hospital stay when given a fat-reduced diet (7.3 ± 5.4 vs. 8.9 ± 4.9 days), the difference was not significant (p = 0.19).
Chylous ascites is a very common postoperative occurrence after right colectomy with extended D3 mesenterectomy and may be prevented using a routine fat-reduced diet.
我们旨在发现接受 D3 扩大肠系膜切除术的患者中乳糜性腹水的发生率，并评估常规低脂饮食（FRD）是否具有预防作用。
前瞻性地收集了 138 例纳入 D3 扩大肠系膜切除术试验的患者的数据。使用外科引流管和引流液的生化检测，在最初的 39 例患者中发现乳糜性腹水的发生率，然后在下 99 例患者中实施预防性低脂饮食作为预防措施。
在最初的 39 例患者中，我们发现 16 例（41.0%）发生乳糜性腹水。实施低脂饮食后，99 例患者中有 1 例（1.0%）发生乳糜性腹水。引流排出量分别为 150 毫升和 80 毫升/天，回归分析显示，低脂饮食组的平均漏液量比无饮食限制组少 105 毫升/天（p<0.001）。其他并发症的发生率无显著差异（Fisher 确切检验，单侧 p=0.8845），尽管给予低脂饮食时住院时间有缩短的趋势（7.3±5.4 天与 8.9±4.9 天），但差异无统计学意义（p=0.19）。
右半结肠切除加 D3 扩大肠系膜切除术术后乳糜性腹水是一种非常常见的术后并发症，可以通过常规低脂饮食来预防。
