Kakinuma Daisuke, Kanazawa Yoshikazu, Matsuno Kunihiko, Masuda Yuka, Ando Fumihiko, Hagiwara Nobutoshi, Fujita Itsuo, Nomura Tsutomu, Yoshiyuki Toshiro, Kato Shunji, Yoshida Hiroshi
Department of Gastrointestinal and Hepato-biliary-pancreatic Surgery, Nippon Medical School.
J Nippon Med Sch. 2021 Jun 30;88(3):242-247. doi: 10.1272/jnms.JNMS.2021_88-310. Epub 2020 Aug 31.
Chylous ascites associated with radical resection of gastric cancer is a serious clinical condition. Lymph node dissection is indispensable during gastrectomy for gastric cancer. However, postoperative chylous ascites prolongs the hospital stay and re-operation. There are few reports on this subject. Most cases of chylous ascites resolve without treatment, but the condition can result in substantial morbidity. The definition of chylous ascites is ambiguous and varies in the English literature. In this report, we discuss a case of chylous ascites in a 68-year-old man who underwent distal gastrectomy for early gastric cancer at our hospital. He was admitted 8 months after surgery with a main complaint of abdominal swelling. Abdominal puncture helped to diagnose chylous ascites with marked elevation of triglyceride level. The patient received a hypercaloric infusion through a central line, and octreotide acetate, but did not improve. After assessment of lymph outflow by lymph scintigraphy, surgical ligation of the lymph vessels was performed through laparotomy. The volume of milky-white ascites in the abdominal cavity was 3,000 mL. Macroscopically, the fluid was confirmed as flowing from behind the common hepatic artery. Thus, ligation was performed. Chylous ascites has not recurred at 12 months after the re-operation. In summary, a case of chylous ascites after radical gastrectomy for gastric cancer was successfully treated by surgery. We review and discuss the relevant literature.
与胃癌根治性切除相关的乳糜性腹水是一种严重的临床病症。在胃癌胃切除术中，淋巴结清扫是必不可少的。然而，术后乳糜性腹水会延长住院时间并需要再次手术。关于这个主题的报道很少。大多数乳糜性腹水病例不经治疗即可自行消退，但这种情况可能导致严重的发病率。乳糜性腹水的定义尚不明确，在英文文献中也有所不同。在本报告中，我们讨论了一例68岁男性的乳糜性腹水病例，该患者在我院接受了早期胃癌远端胃切除术。术后8个月因腹胀为主诉入院。腹腔穿刺有助于诊断乳糜性腹水，甘油三酯水平显著升高。患者通过中心静脉接受高热量输注和醋酸奥曲肽治疗，但病情并未改善。通过淋巴闪烁显像评估淋巴流出情况后，通过剖腹手术对淋巴管进行了手术结扎。腹腔内乳白色腹水的量为3000毫升。肉眼可见，液体从肝总动脉后方流出。因此，进行了结扎。再次手术后12个月乳糜性腹水未复发。总之，一例胃癌根治性切除术后的乳糜性腹水病例通过手术成功治愈。我们回顾并讨论了相关文献。
