A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system

作者：Shibuya Yusuke^*; Asano Koh; Hayasaka Atsushi; Shima Takashi; Akagi Kozo; Ozawa Nobuyoshi; Wada Yuichi

来源：Archives of Gynecology and Obstetrics, 2013, 287(5): 1005-1008.

DOI：10.1007/s00404-012-2666-y

• Chylous ascites
• Lymph node dissection
• Gynecologic cancer
• Conservative treatment
• Serial paracentesis
• Continuous low-pressure drainage system

Postoperative chylous ascites is an unusual complication following retroperitoneal surgery. A search of the English literature showed only 44 cases of chylous ascites following gynecological cancer surgery. The treatment is primarily conservative, but surgical treatment is considered in resistant cases. We developed a novel non-surgical therapeutic strategy for postoperative chylous ascites.
We report a case of severe chylous ascites following pelvic lymph node dissection for gynecological cancer.
Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymph node dissection were performed for a stage II G1 endometrioid adenocarcinoma (FIGO 2009). Forty-one days after surgery, the patient was readmitted due to massive ascites. Repeated paracentesis and a low-fat diet were only partially effective. Fifty-one days after surgery, we started paracentesis with a continuous low-pressure drainage system. Nine days later, there was no further fluid drainage. The patient was asymptomatic and without recurrent disease at follow-up 3 months later.
Pelvic lymph node dissection may cause postoperative chylous ascites. Paracentesis with a continuous low-pressure drainage system can be an effective conservative treatment for postoperative chylous ascites.

• 出版日期2013-5