妇科恶性肿瘤腹腔镜淋巴结清扫术后淋巴漏的影响因素及治疗方法

Risk factors and treatment of lymph leakage after laparoscopic gynecological malignant tumor lymph node dissection

目的分析妇科恶性肿瘤腹腔镜下淋巴结清扫术后淋巴漏的发生危险因素及治疗方法。方法回顾性分析2016年4月-2017年8月190例在该院妇瘤科诊断为妇科恶性肿瘤并接受腹腔镜下腹膜后淋巴结清扫术的患者的临床资料,分析患者术后淋巴漏发生的相关因素及治疗方法,并总结归纳出预防措施。结果 22例(11.58%)患者术后发生淋巴漏,16例为淡黄色引流液,6例为乳糜样引流液。单因素分析显示,淋巴漏组与非淋巴漏组的患者在术前、术后血红蛋白(Hb)、术后血清白蛋白(ALB)水平、淋巴结清扫范围及淋巴结清扫数量这5个因素中存在差异(P <0.05),而Logistic多元回归分析显示,淋巴结清扫范围及术后血清ALB水平是导致术后淋巴漏的影响因素。16例单纯淋巴漏患者经过调整饮食、纠正电解质紊乱、静脉营养及持续引流等保守治疗后治愈。6例伴乳糜漏患者给予禁食、肠外营养、皮下注射生长抑素处理,5例患者治愈,1例患者保守治疗效果不佳行手术结扎后治愈。结论淋巴结清扫范围及术后血清ALB水平是导致术后淋巴漏发生的危险因素。保守治疗及充分引流可获得满意效果,术中选择合适的能量器械并熟练地掌握操作技巧、熟悉解剖和仔细操作可预防淋巴漏发生。

Objective To analyze the risk factors and treatment methods of lymphatic fistula in gynecological malignant tumors.Methods 190 patients who underwent laparoscopic retroperitoneal lymphadenectomy for gynecological malignant tumors at our institution from April 2016 to August 2017 were retrospectively reviewed.190 patients were divided into 2 groups based on the presence(n=22)or absence(n=168)of lymphatic fistula.Results Among the 190 patients,22(11.658%)developed lymphatic fistula.Univariate analysis showed that the preoperative and after surgery hemoglobin,postoperative serum albumin level,range of lymphadenectomy and the number of lymphadenectomy were significantly different between two groups(P<0.05).The analysis of the various features showed that the range of lymphadenectomy and postoperative serum albumin levels were significantly greater in the patients with lymphatic fistula(P<0.05).In all patients,16 lymphatic fistula treated by adjustment diet,electrolyte imbalance correction,intravenous nutrition and continuous drainage and other conservative treatments.6 chylous fistula treated by fasting,parenteral nutrition and injection of somatostatin,and five of them were cured but one needed operation ligation.Conclusion The range of lymphadenectomy and postoperative serum albumin levels are the risk factors for the occurrence of postoperative lymphatic fistula.Conservative treatments and adequate drainage could be satisfied solution.Selecting the appropriate energy equipment,master the operation skills,known well anatomy and careful operation could prevent the occurrence of lymphatic fistula.