Novel management indications for conservative treatment of chylous ascites after gastric cancer surgery

BACKGROUND

Chylous ascites (CA) presents a challenge as a relatively common postoperative complication in gastric cancer (GC). Primary conservative therapy involved total parenteral nutrition, continuous low-pressure drainage, somatostatin, and a low-fat diet. Drainage tube (DT) clamping has been presented as a potential alternative conservative treatment for GC patients with CA.

AIM

To propose novel conservative treatment strategies for CA following GC surgery.

METHODS

The data of patients with CA after GC surgery performed at the Fudan University Shanghai Cancer Center between 2006 and 2021 were evaluated retrospectively.

RESULTS

53 patients underwent surgery for GC and exhibited postoperative CA during the study period. Postoperative hospitalization and time of DT removal showed a significant positive association (R² = 0.979, P < 0.001). We further observed that delayed DT removal significantly extended the total and postoperative hospitalization, antibiotic usage duration, and hospitalization cost (postoperative hospitalization: 25.8 d vs 15.5 d, P < 0.001; total hospitalization: 33.2 d vs 24.7 d, P < 0.01; antibiotic usage duration: 10.8 d vs 6.2 d, P < 0.01; hospitalization cost: ¥9.2 × 10⁴vs ¥6.5 × 10⁴, P < 0.01). Multivariate analysis demonstrated that postoperative infection and antibiotic usage were independent factors for delayed DT removal. Furthermore, DT removal times were shorter in seven patients who underwent DT clamping (clamped DT vs normal group, 11.8 d vs 13.6 d, P = 0.047; clamped DT vs delayed group, 13.6 d vs 27.4 d, P < 0.001). In addition, our results indicated that removal of the DT may be possible after three consecutive days of drainage volumes less than 300 mL in GC patients with CA.

CONCLUSION

Infection and antibiotic usage were vital independent factors that influenced delayed DT removal in patients with CA. Appropriate standards for DT removal can significantly reduce the duration of hospitalization. Furthermore, DT clamping might be a recommended option for conservative treatment of postoperative CA.

[Observation on effect of supplementary treatment by Astragalus injection in treating senile pulmonary tuberculosis patients]

OBJECTIVE

To observe the clinical therapeutic supplementary effect of Astragalus injection (ASI) as anti-tuberculosis agents in treating senile tuberculosis (ST).

METHODS

Seventy-six ST patients were divided according to their hospitalization order into two groups randomly, 39 in the ASI group and 37 in the control group. The anti-tuberculosis regimen applied on all patients were HRE (S)Z for first treated patients and KHZ1321 TH for retreated patients. In the ASI group, ASI was given additionally by adding ASI 20 ml into 500 ml 5% glucose solution for intravenous dripping, once a day. The therapeutic course was 2 months. The changes of focal size, bacteria in sputum, and erythrocyte immune function (EIF) were observed before and after treatment, and the EIF obtained from 30 healthy subjects was taken for control.

RESULTS

EIF in patients of both groups was lower than that in healthy subjects (P < 0.01). Rosette rate of RBC-C3b receptor in both groups was all increased after treatment, the increment was higher in the ASI group than that in the control group significantly (P < 0.01). After 2 months ASI treatment, the effective rate of focal absorption examined by X-ray was 84.6% and the negative conversion rate of bacteria in sputum was 79.4%.

CONCLUSION

ASI has the effect of elevating erythrocyte immunity in senile pulmonary tuberculosis patients, it is able to enhance the therapeutic effect of treatment.