淋巴管显影技术减少腹主动脉旁淋巴结切除术后乳糜漏临床研究

Clinical study on lymphatic imaging technique in reducing chylous leakage after para-aortic lymphadenectomy.

目的探讨妇科恶性肿瘤腹主动脉旁淋巴结切除术前口服花生油术中显影乳糜管及减少乳糜漏的可行性。方法收集2016年1月至2020年12月郑州大学第二附属医院同一治疗团队收治的240例因妇科恶性肿瘤行腹主动脉旁淋巴结切除术的患者的临床资料,根据术前是否口服花生油分为观察组(129例,术前口服花生油)和对照组(111例,术前未口服花生油)。分析观察组术中乳糜管显影率及显影部位,比较两组术后乳糜漏发生率等围手术期资料。结果观察组乳糜漏发生率为3.9%(5/129),乳糜管显影率为93.8%(121/129),显影乳糜管主要分布于左肾静脉下部至肠系膜下动脉以上水平(81.4%,105/129)。对照组乳糜漏发生率为10.8%(12/111)。两组乳糜漏发生率差异有统计学意义(P=0.037),两组在手术方式、术中出血量、淋巴结切除水平、有无淋巴结转移、术前及术后有无贫血等方面差异无统计学意义(P>0.05)。结论术前口服花生油可使术中腹主动脉旁淋巴管清晰显影,便于及时发现受损淋巴管并将其有效凝闭或结扎,从而减少乳糜漏的发生。

Objective To investigate the feasibility of developing chylous duct and reducing chylous leakage by oral administration of peanut oil before para-aortic lymph node resection for gynecological malignant tumor.Methods The clinical data of 240 patients with gynecological malignant tumors who underwent para-aortic lymph node resection were collected from the same treatment team in the Second Affiliated Hospital of Zhengzhou University from January 2016 to December 2020.According to whether peanut oil was taken orally before surgery,they were divided into observation group(n=129 cases,peanut oil was taken orally before surgery)and control group(n=111 cases,peanut oil was not taken).The intraoperative chylous duct development rate and the location of the observation group were analyzed,and the perioperative data,such as the incidence of chylous leakage after operation,were compared between the two groups.Results In the observation group,the incidence of chylous leakage was 3.9%(5/129),and the development rate of chylous duct was 93.8%(121/129).In distribution,chylous duct was mainly distributed from the lower part of the left renal vein to the level above the inferior mesenteric artery(81.4%,105/129).The incidence of chylous leakage in the control group was 10.8%(12/111).There was statistically significant difference in the incidence of chylous leakage between the two groups(P=0.037),but there was no statistically significant difference between the two groups in the operative mode,intraoperative blood loss,lymph node dissection level,lymph node metastasis,or preoperative and postoperative anemia(P>0.05).Conclusion Preoperative oral administration of peanut oil can make the intraoperative lymphatic vessels of the abdominal para-aorta clear,facilitating the timely detection or closure of the damaged lymphatic vessels,thus effectively reducing the incidence of chylous leakage.