胃癌根治术后腹腔淋巴漏的防治

Prevention and treatment of abdominal lymphorrhagia following radical operation of gastric cancer

目的：总结胃癌根治术后腹腔淋巴漏的预防和治疗措施。方法回顾性分析行胃癌根治术的712例患者临床资料。其中标准胃癌根治术604例，扩大胃癌根治术108例。淋巴结清扫过程中淋巴管断端予结扎患者462例，淋巴管断端予电凝250例。胃癌根治术后淋巴漏患者采用全胃肠外营养联合奥曲肽治疗。结果总共有35例（4．92％）患者术后发生腹腔淋巴漏，而行扩大胃癌根治术患者术后淋巴漏发生率（10．19％）比行标准胃癌根治术患者（3．97％）高（P＝0．006）。术中淋巴管断端电凝患者术后淋巴漏发生率（7．6％）比淋巴管断端结扎患者（3．46％）高（P＝0．015）。31例患者经禁食、全胃肠外营养、皮下注射奥曲肽治愈，4例患者加用泛影葡胺冲洗治愈。结论胃癌根治术中淋巴管结扎可以减少术后淋巴漏发生率。全胃肠外营养联合奥曲肽是胃癌根治术后淋巴漏一种有效的治疗方法。

Objective To study the prevention and treatment of abdominal lymphorrhagia following radical operation of gastric cancer.Methods The clinicalpathological data of 712 cases of gastriccancer who underwent radical operation were retrospective1y analyzed.Standard radical operations of gastric cancer were performed in 604 patients,and extended radical operations of gastric cancer were performed in the other 108 patients.Disrupted lymph vessels were ligated in 462 patients and electrically cauterized in 250 patients.Total parenteral nutrition（TPN）with octreotide was administered to all the patientswith lymphorrhagia after radical operation of gastric cancer.Results A total of 35 patients（4.92%）hadlymphorrhagia after radical operation of gastric cancer.The incidence of lymphorrhagia in patients with extended radical operation of gastric cancer was much higher than that in patients with standard radical operation（10.19% vs 3.97%;P =0.006）.In addition,the incidence of lymphorrhagia in patients with electrotome cautery was significantly higher than that in patients who received ligation（7.6% vs 3.46%;P =0.015）.Thirtyone cases of lymphorrhagia were successfully treated with fasting,TPN and subcutaneousinjection of octreotide.The left four cases of lymphorrhagia were cured with meglumine diatrizoate flushing.Conclusion Ligating the disrupted lymph vessels in the radical operation of gastric cancer can minimizethe incidence of lymphorrhagia.The combination of Octreotide and TPN appears to be an effective therapeutic modality for lymphorrhagia.