腹腔镜全膀胱切除术后并发淋巴漏的临床分析

Clinical analysis of postoperative lymphatic leakage after laparoscopic radical cystectomy

目的探讨腹腔镜根治性全膀胱切除术后淋巴漏的发生原因及诊疗策略。方法收集2013年6月至2015年1月大连医科大学附属二院泌尿外科同一术者完成的21例腹腔镜根治性全膀胱切除术患者的临床资料,总结术中所见及术后恢复情况,并对发生淋巴漏患者的原因及治疗情况进行分析。结果 21例患者均于腹腔镜下顺利完成全膀胱切除术,无一例中转开放。19例患者术后5~10 d顺利拔除双侧盆腔引流管;2例（9.5%）术后发生淋巴漏,引流量20~300 m L/d,经指导低脂、高蛋白饮食、通畅引流的保守治疗方法治愈。结论腹腔镜根治性全膀胱切除术后并发淋巴漏是泌尿外科少见并发症。一旦确诊淋巴漏,及早给予指导低脂、高蛋白饮食、通畅引流等保守治疗可获得满意的疗效。

Objective To evaluate the causes,diagnosis and treatment strategies of lymphatic leakage after Laparoscopic Radical Cystectomy（ LRC）. Methods Twenty- one patients,who underwent Laparoscopic Radical Cystectomy and two patients with postoperative lymphorrhagia by the same surgeon at the Department of Urology in the Second Affiliated Hospital of Dalian Medical University from June 2013 to January 2015,were retrospectively reviewed. Results All procedures were successfully completed by laparoscopy and no cases were converted to open surgery. The bilateral pelvic drainage tubes were removed in postoperative 5- 10 d in 19 cases. Two cases（ 9. 5%） had lymphorrhagia postoperatively with a drainage volume of 20- 300 m L / d. Both cases were resolved by conservative treatment measures with a low fat,high protein diet,and unobstructed drainage. Conclusions Lymphatic leakage after LRC is rarely encountered in urologic surgery. When diagnosed,it can be managed as early as possible by low fat,high protein diet,and unobstructed drainage with a satisfactory curative effect.