Analysis And Post Treatment Of The Chylous Fistula After Right Hemicolectomy Of Right Colon Cancer

Objectives:To make a retrospective analysis of post treatment of32chylous fistula e xamples, caused after400right hemicolonic carcinoma patients in gastrointestin al surgery,2008.01.01-2013.01.01.Methods:Between January2008to January2013,400patients who had undergo rih gt hemicolectomy of right colon cancer were included in the study. In the400patients, the clinical data of32patients who had postoperative chylous leakag e were analyzed. Compare effects of sex,age,preoperative complications,location and stage of tumor,the extent and number of lymph node dissection and operat ion methods and time,ect.Results:The incidence of chylous leakage after right hemicolectomy of right colon cancer was8.00%(32/400),4in cecum carcinoma (4/59,6.78%),19in ascendin g colon carcinoma(19/227,8.37%) and9in cancer of hepatic flexure of colon(9/114,7.89%). By the standard of TNM in UICC, the result is3in stage1,8in stage â…¡,21in stage â…¢. By the standard of Dukes, the result is4in stage A,7in stage B and21in stage C. Chylous fistula usually occurs at an average of5days(4--7days) after surgery. The maximum daily drainage volume ranged from200to500ml,with an average of350ml. All the patients were cured cons ervatively and the average healing time is14days(8-20days). During the eleve n factors, hypoproteinemia, category of radical mastectomy(D2or D3) and the number of lymph nodes dissection have statistical significance with the o ccurrence of chylous fistula(P<0.05). Sex,age,diabetes,tumor location,methods an d time of operation,TNM have no clear correlation with chylous fistula(P>0.05).Conclusions:There is a positive correlation between the category of radical mastectomy (D2or D3) and number of lymph nodes dissection with chylous fistula after ri ght hemicolectomy of right colon cancer. In addition, hypoproteinemia also is o ne of the risk factors of chylous fistula. Postoperative chylous leakage should be avoided by intraoperative prevention. Once chylous occurs, supportive and c onservative treatment should be carried out. Emphasis of the lymph ducts, silk ligation and the use of protein glue can help decrease the incidence of chylous fistula.