胰腺手术后难治性乳糜漏的管理：法国全国实践调查及治疗性淋巴管造影多中心研究结果

Management of refractory chyle leak after pancreatic surgery: Results from a French national survey on practices and a multicentric study on therapeutic lymphangiography.

作者信息

Rajaonarison Hélène, Regenet Nicolas, Dokmak Safi, Truant Stéphanie, Piessen Guillaume, Robin Fabien, Richa Yasmina, Sauvanet Alain, Laurent Christophe, Navez Julie, Sulpice Laurent, El Amrani Mehdi

机构信息

Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.

Department of Digestive Surgery, Nantes University Hospital, Nantes, France.

出版信息

Surgery. 2025 Jul 16;186:109541. doi: 10.1016/j.surg.2025.109541.

DOI:10.1016/j.surg.2025.109541

PMID:40674834

Abstract

BACKGROUNDS

Chyle leak is an infrequent complication after pancreatectomy. We aimed to investigate chyle leak management practices in France and evaluate the use of lymphography as a therapeutic tool.

METHODS

A national survey on the diagnosis and treatment of chyle leak after pancreatectomy was sent to 25 surgeons from 25 expert French centers. Subsequently, a comparative retrospective study was conducted. Patients with refractory leaks treated by lymphography in France were screened for inclusion. Patients with refractory leaks treated exclusively with conservative treatment were included in a second group. Refractory chyle leak was defined as a chyle leak that persisted despite a medium-chain triglyceride-enriched diet by the time of the follow-up appointment.

RESULTS

The management of chyle leaks is heterogeneous in France. Only 24% of centers (n = 6) performed lymphography. In total, 33 patients treated by lymphography (30.3% bipedal, 69.7% transnodal) and 23 patients treated conservatively between 2010 and 2023 were identified. Compared with conservative treatment alone, patients undergoing lymphography within 25 days of surgery (n = 25) had significantly fewer abdominal collections (34.6% vs 69.6%, P = .011), radiologic-identified drainage (23.1% vs 60.9%, P = .01), and readmission for recurrence (3.8% vs 26.1%, P = .041).

CONCLUSION

Lymphography is safe and represents a potentially effective option to treat refractory chyle leaks within 25 days of surgery.

摘要

背景

乳糜漏是胰腺切除术后一种罕见的并发症。我们旨在调查法国乳糜漏的处理方法，并评估淋巴管造影作为一种治疗手段的应用情况。

方法

向来自25个法国专家中心的25名外科医生发送了一份关于胰腺切除术后乳糜漏诊断和治疗的全国性调查问卷。随后，进行了一项对比性回顾性研究。筛选出在法国接受淋巴管造影治疗难治性乳糜漏的患者纳入研究。另一组纳入仅接受保守治疗的难治性乳糜漏患者。难治性乳糜漏定义为在随访预约时，尽管采用了富含中链甘油三酯的饮食，乳糜漏仍持续存在。

结果

法国乳糜漏的处理方法存在差异。只有24%的中心（n = 6）进行淋巴管造影。在2010年至2023年期间，共确定了33例接受淋巴管造影治疗的患者（双足法30.3%，经淋巴结法69.7%）和23例接受保守治疗的患者。与单纯保守治疗相比，在术后25天内接受淋巴管造影的患者（n = 25）腹腔积液明显较少（34.6%对69.6%，P = 0.011），影像学确定的引流情况较少（23.1%对60.9%，P = 0.01），因复发再次入院的情况较少（3.8%对26.1%，P = 0.041）。