SiewertⅡ型、Ⅲ型胃食管结合部癌腹腔镜辅助根治性切除术后乳糜漏的影响因素探讨

Risk factors associate with chylous leakage following lapraroscopic -assisted radical gastrectomy in siewert type II, III gastroesophageal junction cancer

目的探讨SiewertⅡ型、Ⅲ型胃食管结合部癌腹腔镜辅助根治性切除术后乳糜漏的影响因素。方法回顾性分析370例SiewertⅡ型、Ⅲ型胃食管结合部胃癌患者的临床及病理资料，比较术后发生乳糜漏组和未发生乳糜漏组在年龄、性别、术前是否存在贫血、低蛋白血症、术前辅助化疗、胃切除范围、T分期、N分期、清扫淋巴结数目及转移淋巴结数目的差异，分析术后乳糜漏与胃周各组淋巴结的关系，并采用Logistic回归进行多因素分析。结果术后乳糜漏患者共13例（3．5％），其中男10例，女3例；6例患者存在术前贫血和低蛋白血症，7例患者进行了术前辅助化疗，术后病理显示7例患者NO．9淋巴结转移。乳糜漏组清扫淋巴结数目（20．31±4．97）枚，非乳糜漏组清扫淋巴结（17．85±6．08）枚，乳糜漏组转移淋巴结数目（5．01±4．42）枚，而非乳糜漏组为（3．77±3．12）枚。在年龄、性别、术前贫血、胃切除范围、肿瘤的T分期及N分期和清扫淋巴结数目方面差异均无统计学意义（P〉0．05）。单因素及多因素分析显示，NO．9淋巴结转移、术前低蛋白血症、术前辅助化疗及转移淋巴结数目是影响术后乳糜漏的独立危险因素（P〈0．05）。结论术前低蛋白血症、转移淋巴结数目、术前辅助化疗、NO．9淋巴结转移的患者施行腹腔镜胃食管结合部癌D2根治术后乳糜漏发生的风险显著增加，术中应积极进行预防。

Objective To investigate risk factors associate with chylous leakage following lapraro- seopic - assisted radical gastreetomy in Siewert type II , III gastroesophageal junction cancer. Methods Clinical and pathological data of 370 patients with gastric cancer undergone laparoscopic - assisted radical gastrectomy in Siewert type II , III gastric cancer in our group were analyzed retrospectively between postop- erative ehylous leakage group and no chylous fistula group. To explore the relationships among ehylous leakage with age, gender, preoperative anemia, hypoalbuminemia, preoperative chemotherapy, gastric re- section, range of gastric resection, T stage, N stage, number of lymph nodes dissection, number of metastaic lymph node, risk factors assoctiate with postoperative chylous leakage were investigated by univa- riate and multivariate analysis. The recovery were also analyzed between two groups. Results 13 patients （3. 5% ） showed symptoms of ehylous leakage after operation in total, including 10 males and 3 females. while preoperative anemia, hypoalbuminemia appeared in 6 patients and 7 patients undergone preoperative chemotherapy. 7 patients showed NO. 9 lymph node metastasis in postoperative pathology. The number of lymph nodes dissection between ehylous leakage after operation group and non-ehylous leakage after opera- tion group is 20. 31 ±4. 97 vs. 17.85±6.08 ,while the number of metastatic lymph nodes is 5.01 ±4. 42 vs. 3.77 ± 3. 12. No statistically significance showed on age, gender,preoperative anemia, range of gastric resection,T stage, N stage, number of lymph nodes dissection. Univariate and multivariate analysis shows that NO. 9 lymph node metastasis, preoperative hypoalbuminemia, the number of metastatic lymph nodes, preoperative adjuvant chemotherapy is independent risk factors for postoperative chylous leakage （P 〈 0. 05）. Conclusion Risk of chylous leakage in patients with preoperative hypoproteinemia, metastatic lymph nodes, especially NO. 9 lymph node metastasis, preoperative chemotherapy undergone laparoseopic radical gastrectomy with D2 dissection of gastric cancer significantly increased, who should be actively prevention.