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相關文獻
- Refractory Chylous Ascites Treated with the Vascularized Lymphatic Cable Flap via an Alternative Route--A Case Report and Review of the Literature
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| 題 名 | Refractory Chylous Ascites Treated with the Vascularized Lymphatic Cable Flap via an Alternative Route--A Case Report and Review of the Literature=以淋巴索治療難治性乳糜腹水--病例報告及文獻回顧 |
|---|---|
| 作 者 | 黃循敬; 陳宏基; | 書刊名 | 臺灣整形外科醫學會雜誌 |
| 卷 期 | 28:1 2019.03[民108.03] |
| 頁 次 | 頁41-48 |
| 分類號 | 416.264 |
| 關鍵詞 | 淋巴索; 乳糜腹水; 淋巴索移植; Chylous ascites; Lymphatic cable flap; Vascularized lymph node transfer; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:乳糜腹水是指富含脂質之淋巴液因淋巴系統受損而流入腹腔內所造成,其成因包含淋巴管的創傷性損傷或阻塞。對於大部分患者而言,保守治療一般已可達到治療的效果。然而,針對難治性乳糜腹水,手術或許是最後的治療方法。過去,我們曾發表關於淋巴索移植以治療難治性乳糜腹水之文獻,並得到優良結果。目的及目標:我們報告一個以淋巴索移植來治療難治性乳糜腹水的個案。此個案是透過另一路徑引流乳糜腹水。材料及方法:一位患有末期腎病症候群並持續接受腹膜透析的60歲女性病患,因左側腎盂移行細胞癌併主動脈旁淋巴結轉移而接受腹腔鏡雙側腎輸尿管切除和左主動脈旁淋巴結廓清術,並接受術後化學治療。於術後一個月,病患因大量乳糜腹水而就診,並接受約三個月的保守治療。但效果並不理想。最終,患者接受了淋巴索移植手術。透過腹壁正中切線,我們可從腹直肌的內側緣到達腹直肌後鞘並分離出深下腹壁血管和周邊脂肪淋巴組織(深下腹壁淋巴索皮瓣)。透過同一傷口可進入腹腔,分離出右胃網膜淋巴組織瓣。將深下腹壁淋巴索皮瓣和右胃網膜淋巴組織瓣進行吻合(右下腹壁動靜脈和右胃網膜動靜脈端對端吻合)(此方式和過去的引流路徑相異)。深下腹壁淋巴索皮瓣周邊脂肪淋巴組織錨定在右側胃網膜上以防止扭結。此錨定方式並不會造成腸彎,進而造成腸扭結/腸阻塞之現象。結果:病患在術後一個月內症狀明顯得到緩解。在術後1年的追蹤,病患完全脫離了乳糜腹水的困擾,之後也移除了腹膜透析導管。結論:淋巴索移植能夠通過引導腹內淋巴回流進入腹外淋巴系統來解決難治性乳糜腹水。無論是新路經或是舊路經皆能達到優良的結果。此個案之新方式更為快速簡單。 |
| 英文摘要 | Background: Chylous ascites is the leakage of lipid-rich lymph into the peritoneal cavity, which occurs due to disruption of lymphatic system secondary to traumatic injury or obstruction. Conservative treatment is usually sufficient in most patients with chylous ascites. However, surgical management could be an option for patients who are refractory to medical treatment. Lymphatic cable flap based on deep inferior epigastric vessels is a promising treatment option for patients with refractory chylous ascites. Aim and Objectives: We report a case of refractory chylous ascites treated with the vascularized lymphatic cable flap via an alternative route. The new method applies similar principle, but uses different organ. Moreover, this case is not included in our previously published paper. Materials and Methods: A 60-year-old woman with end-stage renal diseases who undergone continuous ambulatory peritoneal dialysis suffered from left renal pelvis urothelial carcinoma with para-aortic lymph node metastasis. The patient had chemotherapy followed by laparoscopic bilateral nephroureterectomy and left para-aortic lymphadenectomy. One month after oncologic resection, the patient developed massive chylous ascites. She was referred to us after 3 months of conservative treatment. Surgical treatment with the vascularized lymphatic cable flap based on deep inferior epigastric vessels was performed. Results: The patient had significant symptomatic relief within 1 month after the surgery. At 1-year follow-up, the Tenckhoff catheter was removed and the chylous ascites was completely resolved. Conclusion: The lymphatic cable flap, based on deep inferior epigastric vessels, with surrounding fat and lymphatic tissues, can bypasses the incompetent intraperitoneal lymphatics through an extraperitoneal route. This is one of the good options for treatment of refractory chylous ascites. Whether the old method or new method, both are effective in treating refractory chylous ascites. However, omentum lymphatic tissue flap is an easier procedure than our previous method. |
本系統中英文摘要資訊取自各篇刊載內容。