下肢继发性淋巴水肿脂肪抽吸术失血量的影响因素分析

Analysis of risk factors of blood loss during liposuction for secondary lymphedema of lower extremities

目的分析下肢继发性淋巴水肿脂肪抽吸术治疗中失血量的影响因素。方法回顾性分析2019年1至12月首都医科大学附属北京世纪坛医院淋巴外科收治的下肢继发性淋巴水肿行脂肪抽吸术患者的临床资料。术前、术后各项指标[年龄、体质量、体质量指数(BMI)、原发病、高血压史、放疗史、化疗史、丹毒史、患肢侧别、肿胀病史、距原发病病史、国际淋巴协会(ISL)分期、手术时间、肿胀液量、抽脂量、血水量、体积差、术前血红蛋白]与失血量行相关性分析,连续变量单因素分析采用多元Pearson相关性分析,分类变量单因素分析采用Spearman相关性分析,连续变量多因素分析采用多重线性回归,分类变量多因素分析采用多元Logistic回归,P<0.05为差异有统计学意义。结果共纳入174例患者,均为女性,年龄为55.0(47.5,63.0)岁,失血量相关性单因素分析显示:年龄(r=0.17,P=0.026)、体质量(r=0.37,P<0.001)、BMI(r=0.29,P<0.001)、高血压史(r=0.25,P=0.001)、ISL分期(r=0.40,P<0.001)、手术时间(r=0.44,P<0.001)、肿胀液量(r=0.53,P<0.001)、抽脂量(r=0.36,P<0.001)、血水量(r=0.61,P<0.001)、体积差(r=0.63,P<0.001)与失血量相关,原发病、放疗史、化疗史、丹毒史、患肢侧别、肿胀病史、距原发病病史、术前血红蛋白与失血量均无相关性(P均>0.05);失血量相关性多因素分析显示:高血压史(r=0.14,P=0.012)、手术时间(r=0.15,P=0.019)、体积差(r=0.30,P=0.001)是影响失血量的独立危险因素。结论高血压史、手术时间、体积差是影响下肢继发性淋巴水肿脂肪抽吸术失血量的危险因素。

Objective To explore the blood loss during liposuction for secondary lymphedema of the lower extremities and to analyze the risk factors that influence the blood loss.Methods Retrospective analysis of the clinical data of patients with secondary lymphedema of lower extremities at the Department of Lymphatic Surgery,Capital Medical University Affiliated Beijing Shijitan Hospital from January 2019 to December 2019.The following clinical indicators were correlated with the amount of blood loss,including age,body mass,body mass index(BMI),primary disease,hypertension,radiotherapy history,chemotherapy history,erysipelas history,affected extremity,duration of swelling,duration of primary disease,International Society of Lymphology(ISL)stage,time of operation,infiltration volume,fat aspiration,blood-tinged fluid solution,volume difference,preoperative hemoglobin.Pearson analysis was used for the univariate analysis of continuous variables,Spearman analysis was used for the univariate analysis of classified variables,multiple linear regression was used for multivariate analysis of continuous variables,and Logistic regression was used for the multivariate analysis of classified variables.Results 174 patients were enrolled,all females with a median age of 55 years.Univariate analysis showed that the age(r=0.17,P=0.026),the body mass(r=0.37,P<0.001),BMI(r=0.29,P<0.001),hypertension(r=0.25,P=0.001),the ISL stage(r=0.40,P<0.001),operative time(r=0.44,P<0.001),infiltration volume(r=0.53,P<0.001),fat aspiration(r=0.36,P<0.001),blood-tinged fluid solution(r=0.61,P<0.001)and volume difference(r=0.63,P<0.001)were associated with the blood loss.There was no correlation between primary disease,radiotherapy history,chemotherapy history,erysipelas history,affected extremity,duration of swelling,duration of primary disease,preoperative hemoglobin and blood loss(P>0.05).Multivariate analysis showed that hypertension(r=0.14,P=0.012),operative time(r=0.15,P=0.019)and volume difference(r=0.30,P=0.001)were independent risk factors affecting blood loss.Conclusion Hypertension,operative time and volume difference are the risk factors of blood loss during liposuction for secondary lymphedema of the lower extremities.