目的评价全麻复合硬膜外阻滞(GEA)与全麻(GA)对乳糜外瘘患者围术期IL-6和皮质醇水平的影响。方法选择20例ASAⅠ~Ⅱ级乳糜外瘘择期行腹膜后淋巴管结扎加自体静脉分流术的患者,随机分为全麻复合硬膜外组(GEA组,n=10)和全麻组(GA组,n=10)。采用放免技术分别测定两组病人麻醉诱导前(T1)、插管后3分钟(T2)、手术后2小时(T3)和拔管后5分钟(T4)血清IL-6和皮质醇的水平。结果IL-6在T1和T2时刻GEA组和GA组比较,差异无统计学意义,T3和T4时刻GEA组低于GA组,差异有统计学意义;皮质醇在T1时刻GEA组和GA组比较,差异无统计学意义,T2~T4时刻GEA组低于GA组,差异有统计学意义。结论GEA能够较好地抑制乳糜外瘘患者围术期IL-6和皮质醇的过度升高,GEA较GA更适合乳糜外瘘患者行腹膜后淋巴管结扎加自体静脉分流术。
OBJECTIVE:To discuss the diagnosis and therapy of chylous ascites.METHODS:To diagnose 40 patients of chylous ascite with regular test and quantitative analysis of chyle, direct lymphangiography, CT (immediately after direct lymphangiography), lymphangioscintigraphy, MRI. Twenty-two patients received conservative therapy, 18 patients received retroperitoneal lymphangiectomy and (or) lymph-vein shunting.RESULTS:Lymphatic dysplasia and chylous reflux were found in almost every patient, total parenteral nutrition showed good results. Followed up from 1 month to 5 years, in conservative therapy group, 9 patients were controlled well clinically, the condition of 6 patients was improved better. Seven patients showed no effect. In operation group, 11 patients were controlled well clinically. Four patients got mitigated. Total 7 patients died, although 4 of them ameliorated temporarily.CONCLUSIONS:Direct lymphangiography, CT (immediately after direct lymphangiography) are the most important diagnosis methods. The influence of the therapy to the malformed lymphatic system of patients should be well considered. Lymph-vein shunting, such as thoracic duct-left external jugular vein anastomosis, gastroenteral or retroperitoneal lymphatics-testicular or ovarian vein anastomosis, could improve the circulation of lymph and chyle of patients. Lymphatic microsurgery will play more and more important roles in the treatment of chylous diseases.
失蛋白性肠病(PLE)是血浆蛋白由肠道大量丢失而导致低蛋白血症的一种综合征.肠淋巴回流障碍是导致该病的常见病因之一.1999年7月至2003年1月,我们共收治肠淋巴回流障碍导致的PLE4例,报告如下.
目的探讨淋巴管静脉吻合治疗乳糜尿的新术式,以进一步提高疗效.方法选择经腹股沟疝切口寻找髂外淋巴管与腹壁下静脉并在显微镜下进行吻合.结果经术后随访6个月～7年,乳糜尿肖失9例,明显减轻4例,无效1例.结论该术式在腹膜后寻找的髂外淋巴管直径较粗且距瘘口较近,利于吻合和淋巴液直接快速分流,术后疗效满意.
目的探讨肢体淋巴水肿疾病中相关恶性肿瘤的诊断与治疗.方法对我院 1988年10月至2000年12月收治的332例肢体淋巴水肿患者,根据临床表现,用B超、淋巴管造影、静脉造影或CT等手段作为病因诊断检查,对可疑恶性肿瘤病例用穿刺、局部切除或局部探查的方法共活检20例.结果检出由恶性肿瘤引发的淋巴水肿18例,其中原发淋巴系统恶性肿瘤4例,均为下肢; 继发性淋巴结转移癌14例,上、下肢各7例,并予相应治疗.结论重视本病临床表现,可使患者获得及早诊断,及时治疗.
OBJECTIVE To discuss the diagnosis and therapy of chylous reflux and external chylous fistula. METHODS All of 6 patients were diagnosed with direct lymphagiography, lymphscintigraphy. Among them, 2 patients received CT after direct lymphagiography. Retroperitoneal lymphangiectomy plus lymph-vein shunting was performed in 5 patients, and retroperitoneal lymphangiectomy in 1 patient. RESULTS The 6 patients were followed up from 6 months to 6 years. In 5 patients, chylous cysts disappeared and chylous fistula closed, and in 1 patient, chylous fistula didn't cicatrize, and chyle still leak out from the scrotum. CONCLUSIONS Retroperitoneal lymphangiectomy plus lymph-vein shunting has curative effect on chylous external fistula of the lower extremity and genitalia, but it has the chance to not obstruct all paths of chylous reflex.
目的探讨乳癌术后上肢肿胀的诊断与治疗. 方法对40例乳癌术后上肢肿胀患者,采用B超、CT、淋巴管造影、静脉造影、穿刺活检、腋窝探查等做进一步诊断,对于单纯淋巴水肿的患者行显微淋巴管静脉吻合术(LVA). 结果 40例中7例发现癌转移,3例淋巴水肿合并静脉回流障碍,30例为单纯淋巴水肿行LVA,近期均有效,远期有效率83.3%. 结论乳癌术后肢体肿胀,部分与乳癌转移及静脉回流障碍有关.高频B超下穿刺活检可作为常规诊断癌转移的手段.少数病例,只有探查性手术才能确诊.LVA可作为乳癌手术放疗后淋巴水肿的首选方法.
