Wang Ke, Xiao Jiaming, Li Li, Li Xu, Yang Yilun, Liu Zhiyu, Jiang Jing
Department of Clinical Nutrition, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
Department of Nutrition and Food Hygiene, School of Public Health, Dalian Medical University, Dalian, Liaoning, China.
Front Nutr. 2023 Jul 20;10:1128864. doi: 10.3389/fnut.2023.1128864. eCollection 2023.
Post-operative chylous leakage (CL) is the pathologic leakage of chylomicron fluid after surgery. This retrospective study was performed to evaluate a uniform oral nutrition management strategy on the post-operative CL.
We retrospectively reviewed patients who developed post-operative CL and received consultation from a clinical nutritionist in seven departments of the Second Affiliated Hospital of Dalian Medical University from May 2020 to April 2022. We designed the oral nutrition intervention program which mainly standardized the type and amount of foods contained in the medium-chain triglyceride (MCT) diet. The influencing factors of curative efficacy were analyzed. Finally, binary logistic regression analysis was conducted to observe the relationship between curative efficacy and potentially predictive variables, including post-operative albumin, post-operative hemoglobin, surgical procedure, and drainage volume at consultation.
Sixty-three patients with post-operative CL were included in this analysis. Of this number, 58 patients were cured successfully without other treatments. Three patients had a significantly prolonged recovery period, and the remaining two cases were treated by reoperation therapy. The leakage volume at the initiation of enteral intervention had no statistically significant difference in seven surgical departments and surgical sites (left, right, median, and bilateral). The length of stay (LOS) of patients with CL after the intervention was not significantly increased in cardiac, hepatobiliary, gastrointestinal, and urological surgeries. Patients with CL had longer LOS than those without CL in gynecology (=0.044) and thyroid surgery departments (=0.008). Each unit increase in post-operative hemoglobin would increase the probability of an effective outcome by 8%, which was statistically significant ( = 0.037).
In treating patients with post-operative CL, we recommend the MCT diet and EN as the first option, rather than fasting, parenteral nutrition (PN), or octreotide.
术后乳糜漏（CL）是手术后乳糜微粒液的病理性渗漏。本回顾性研究旨在评估一种统一的口服营养管理策略对术后CL的影响。
我们回顾性分析了2020年5月至2022年4月在大连医科大学附属第二医院七个科室发生术后CL并接受临床营养师咨询的患者。我们设计了口服营养干预方案，主要规范了中链甘油三酯（MCT）饮食中所含食物的类型和数量。分析了疗效的影响因素。最后，进行二元逻辑回归分析，观察疗效与潜在预测变量之间的关系，包括术后白蛋白、术后血红蛋白、手术方式以及咨询时的引流量。
本分析纳入了63例术后CL患者。其中，58例患者未经其他治疗成功治愈。3例患者恢复期明显延长，其余2例采用再次手术治疗。七个手术科室和手术部位（左侧、右侧、正中及双侧）在肠内干预开始时的漏液量无统计学差异。心脏、肝胆、胃肠和泌尿外科手术后，CL患者的住院时间（LOS）没有显著增加。在妇科（=0.044）和甲状腺外科（=0.008），CL患者的LOS比无CL患者更长。术后血红蛋白每增加一个单位，有效结局的概率将增加8%，具有统计学意义（=0.037）。
在治疗术后CL患者时，我们建议首选MCT饮食和肠内营养（EN），而非禁食、肠外营养（PN）或奥曲肽。
