乳糜外瘘患者常由于先天性淋巴管畸形或发育不全,导致淋巴回流障碍[1],腹膜后淋巴管结扎加静脉吻合术治疗乳糜外瘘是惟一有效的手段[2,3],该手术时间长(8～10h),包含常规腹部手术和淋巴显微外科手术两个过程,器械护士与医生的配合难度较大.2002年1月至2005年1月我院淋巴外科共完成9例腹膜后淋巴管结扎加静脉吻合术,效果满意,现将手术配合总结如下.

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 study the influence of propofol(P),etomidate(E)and isoflurane(I)on blood glucose and insulin levels in patients of stomach carcinoma during the radical operation.Methods:Thirty patients(ASAⅠ～Ⅱ)of stomach carcinoma undergoing radical operations were randomly divided into P,E and I groups.Blood samples were drawn from peripheral vein 5?minutes before anesthesia,60?minutes after anesthesia and 5?minutes postoperatively.The blood glucose and the serum insulin were determined.Ten healthy individuals were used as control group.Results:There was no difference in blood glucose and insulin levels 5 minutes before anesthesia in P,E and I groups than control group(P0.05).At 60?minutes after anesthesia and 5 minutes postoperatively the blood glucose was higher than that 5 minutes before anesthesia,the serum insulin was lower than that 5 minutes before anesthesia in P,E and I groups(P0.05).There was no difference on blood glucose and serum insulin level among P,E and I groups(P0.05).Conclusion:The blood glucose increases and the serum insulin decreases during the radical operation of stomach carcinoma which caused by perioperative stress.P,E and I can not remarkably influence this process.

乳糜外瘘(external chylous fistula)通常由于腹膜后淋巴管先天发育畸形导致的淋巴液回流障碍引起,手术结扎和切除腹膜后粗大的淋巴管并行淋巴管-静脉分流手术是目前惟一有效的治疗方法[1].围手术期护理是腹膜后淋巴管结扎加静脉分流术成功的重要因素之一,现将我院淋巴外科近期实施的6例腹膜后淋巴管结扎加静脉分流术围手术期的护理报道如下.