背景:乳糜腹水(CA)作为胃癌(GC)中相对常见的术后并发症提出了挑战。主要的保守治疗包括全胃肠外营养,连续低压排水,生长抑素,低脂饮食.引流管(DT)夹紧已被认为是CAGC患者的潜在替代保守治疗方法。
目的:为GC手术后的CA提出新的保守治疗策略。
方法:回顾性分析2006-2021年复旦大学附属上海肿瘤防治中心行GC术后的CA患者资料。
结果:53例患者接受了GC手术,在研究期间显示术后CA。术后住院时间与DT切除时间呈正相关(R2=0.979,P<0.001)。我们进一步观察到延迟的DT切除显著延长了总住院时间和术后住院时间。抗生素使用持续时间,和住院费用(术后住院:25.8dvs15.5d,P<0.001;总住院:33.2dvs24.7d,P<0.01;抗生素使用持续时间:10.8dvs6.2d,P<0.01;住院费用:9.2×104日元对6.5×104日元,P<0.01)。多因素分析表明,术后感染和抗生素使用是延迟去除DT的独立因素。此外,接受DT钳夹的7例患者的DT清除时间较短(钳夹的DT与正常组相比,11.8dvs13.6d,P=0.047;固定的DT与延迟组相比,13.6dvs27.4d,P<0.001)。此外,我们的结果表明,对于患有CA的GC患者,在连续3天的引流量小于300mL后,可以清除DT.
结论:感染和抗生素使用是影响CA患者延迟去除DT的重要独立因素。适当的DT去除标准可以显着减少住院时间。此外,DT钳夹可能是术后CA保守治疗的推荐选择。
BACKGROUND: Chylous ascites (CA) presents a challenge as a relatively common postoperative complication in gastric cancer (GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Drainage tube (DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.
OBJECTIVE: To propose novel conservative treatment strategies for CA following GC surgery.
METHODS: The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.
RESULTS: 53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association (R 2 = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost (postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001; total hospitalization: 33.2 d vs 24.7 d, P < 0.01; antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01; hospitalization cost: ¥9.2 × 104 vs ¥6.5 × 104, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal. Furthermore, DT removal times were shorter in seven patients who underwent DT clamping (clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047; clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.
CONCLUSIONS: Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.