刘佳敏?吴思雨?温丹婷?肖静

【摘要】淋巴漏是一种妇科肿瘤术后罕见并发症，其临床特征主要为腹部引流出乳糜样或淡黄色液体。该病诊断困难、治疗方案未统一。该文报道一例卵巢癌术后1个月出现反复大量腹腔积液的患者，入院时合并腹膜炎，辅助检查可排除乳糜漏，考虑为术后淋巴漏合并感染;予诊断性治疗，治疗后患者症状好转出院，文章结合相关文献对病例资料进行分析总结，阐述淋巴漏的典型临床表现和诊治方案进展，以期引起临床医师的重视，为该病的诊断及治疗提供支持。

【关键词】淋巴漏;腹水;卵巢癌;乳糜漏

Intractable lymphatic leakage after lymphadenectomy for ovarian cancer： one case report Liu Jiamin， Wu Siyu， Wen Danting， Xiao Jing. The Second Clinical College of Guangzhou University of Chinese Medicine， Guangzhou 510000， China

Corresponding author， Xiao Jing， E-mail： xiaojingson_2004@ 126. com

【Abstract】Lymphatic leakage is a rare postoperative complication of gynecological tumor surgery， which is mainly characterized by abdominal drainage of chylous or yellowish fluid. It is difficult to make diagnosis and no standard therapeutic regime has been determined. In this article， the patient presenting with recurrent massive peritoneal effusion at a month after ovarian cancer surgery was reported. Upon admission， the patient was complicated with peritonitis. The possibility of chylous leakage was excluded by auxiliary examination. The patient was diagnosed with postoperative lymphatic leakage complicated with infection. After diagnostic treatment， relevant symptoms were significantly improved and the patient was discharged from hospital. Combined with relevant literature review， clinical data of this case were analyzed and summarized. Typical clinical manifestations and research progress on the diagnosis and treatment of lymphatic leakage were illustrated， aiming to provide evidence for the diagnosis and treatment of this disease.

【Key words】Lymphatic leakage;Ascites;Ovarian cancer;Chylous leakage

淋巴漏指各种原因导致的淋巴液从循环系统中漏出，是一种罕见并会导致一系列并发症、甚至危及生命的疾病[1]。广义的淋巴漏包括乳糜漏和狭义的淋巴漏，具体由淋巴管损伤的解剖位置决定，其中又以发生在腹腔部位的乳糜漏报道居多。妇科肿瘤淋巴结切除术后，乳糜漏的发病率约为3%[2-3]。与乳糜漏相比，淋巴漏更为罕见，其诊断、鉴别诊断及治疗都极具挑战性，目前有关淋巴漏仅有个案报道，且数量极少，未形成公认的诊治规范。本文报道一例卵巢癌淋巴切除术后顽固性淋巴漏致反复大量腹腔积液病例，回顾其中西医诊断及治疗过程，并结合文献复习提供临床经验及思路，以飧同道。

病例资料

一、主诉、病史及体检检查

患者女，46岁。因卵巢黏液腺癌ⅡA期术后化学治疗后3个月，反复腹胀5月余，加重1周于2020年5月13日收入我科。……