胃癌根治术后腹腔淋巴漏并腹腔感染的临床分析

Clinical analysis of lymphorrhagia with infection in abdominal cavity after radical operation of gastric cancer

目的探讨胃癌根治术后腹腔淋巴漏并腹腔感染的影响因素以及预防措施。方法回顾性分析2000年6月-2010年6月行胃癌根治术的1246例患者的临床病理资料。结果 1246例患者胃癌根治术后发生腹腔淋巴漏并感染的发生率为1.0%,贫血(P=0.029)、低蛋白血症(P=0.017)、肿瘤分期(P=0.000)以及手术方式(P=0.000)是胃癌根治术后发生腹腔淋巴漏并感染的影响因素;有8例(61.5%)引流量<300ml未作特殊处理,1周后予以拔除引流管并缝合引流管口;其余5例(38.5%)采用肠外营养(TPN),以及奥曲肽治疗后腹腔引流液减少至<300ml后,予以拔除引流管,所有患者均无明显不良反应。结论胃癌根治术后腹腔淋巴漏并感染与贫血和低蛋白血症、肿瘤分期以及手术方式有关,术前充分准备,术中选择合适的手术范围,是预防胃癌根治术后腹腔淋巴漏并感染的有效方法。

OBJECTIVE To investigate the impact factors and preventive measures of lymphorrhagia and infection in abdominal cavity after radical surgical operation for gastric cancer. METHODS The clinical pathologic data of 1246 cases of gastric cancer who underwent radical surgical operation from Jun 2000 to Jun 2010 were retrospectively analyzed. RESULTS The incidence of lymphorrhagia and infection in abdominal cavity after the radical operation of gastric cancer was 1.0%. Anaemia （P=0. 029）, hypoproteinemia （P=0. 017）, tumor staging （P=0. 000）, and surgical methods （P = 0. 000） were significantly related to the incidence of lymphorrhagia and infection in abdominal cavity. In 8 cases （61.5%） whose drainage quantity were less than 300ml per day, the drainage tube was removed and the skin was sutured in one week after operation. The other 5 cases （38.5%） were treated with parenteral nutrition and octreotide, and the drainage tubes were removed when drainage quantity reduced to less than 300ml per day. All cases were not found obvious side effect. CONCLUSION The lymphorrhagia and infection is highly related to the anaemia, hypoproteinemia, tumor staging, and surgical methods. Preoperative full preparation and appropriate surgical method are effective way for lymphorrhagia and and infection after the radical operation of gastric cancer.