160例腹腔镜根治性膀胱切除术后淋巴漏的影响因素分析

doi:10.6040/j.issn.1671-7554.0.2019.1307

摘要/Abstract

摘要： 目的探讨导致腹腔镜根治性膀胱切除术后淋巴漏出现的相关因素,并研究各因素在术后淋巴漏的预防及治疗中的作用。方法回顾2015年1月至2019年1月在山东大学齐鲁医院泌尿外科行腹腔镜根治性膀胱切除术患者共计160例,查阅文献并制定标准后将患者分为淋巴漏及非淋巴漏组,收集其年龄、淋巴结清扫范围、淋巴结数量、阳性淋巴结数量、是否存在阳性淋巴结、清扫后是否Hemolock夹闭淋巴组织、术前及术后血红蛋白(HGB)、术后白蛋白(ALB)等临床资料,采用单因素及多因素分析患者术后发生淋巴漏的有关因素。结果研究共纳入的160例患者中,其中有44例(27.5%)诊为淋巴漏,单因素t检验及χ²检验显示阳性淋巴结数量、清扫后是否Hemolock夹闭淋巴组织与淋巴漏发生有关联,清扫后Hemolock夹闭淋巴组织可明显降低术后淋巴漏的发生(t=2.477, χ2=41.215, P<0.05),二元Logistic回归分析显示清扫后是否Hemolock夹闭淋巴组织与淋巴漏发生有关联(OR=18.482, 95%CI:6.872~49.709,P<0.001)。患者经禁饮食、通畅引流等保守治疗均治愈。结论阳性淋巴结数量及清扫后是否Hemolock夹闭淋巴组织是术后淋巴漏发生的高危因素。通过饮食、引流及其他治疗措施均可治愈,术中熟练地掌握操作技巧、淋巴结清扫后Hemolock夹闭淋巴组织、熟悉解剖和仔细操作可预防淋巴漏发生。

关键词: 淋巴漏, 膀胱癌, 腹腔镜根治性膀胱切除, 盆腔淋巴结清扫术

Abstract: Objective To investigate the factors leading to lymphatic leakage after laparoscopic radical cystectomy(LRC), and to explore their roles in the prevention and treatment of postoperative lymphatic leakage. Methods The clinical data of 160 patients who underwent LRC at the Urology Department of Qilu Hospital of Shandong University from Jan. 2015 to Jan. 2019 were retrospectively analyzed and relevant literature was reviewed. The patients were divided into leakage group and non-leakage group. Patients age, lymph node dissection range, number of lymph nodes, number of positive lymph nodes, whether the lymphatic tissues were clapped with Hemolock after dissection, preoperative and postoperative hemoglobin(HGB), postoperative albumin(ALB)were collected to analyze factors associated with postoperative lymphatic leakage. Results Lymphatic leakage was detected in 44(27.5%)patients. One-way t-test and χ2 test showed the number of positive lymph nodes and whether lymphatic tissues were clamped with Hemolock after dissection were associated with occurrence of lymphatic leakage, and the latter could significantly reduce incidence of lymphatic leakage(t=2.477, χ2=41.215, P<0.05). Logistic regression analysis showed lymphatic leakage was associated with whether lymphatic tissues were clamped with Hemolock after dissection(OR=18.482, 95%CI:6.872-49.709, 山东大学学报 (医学版)58卷1期 -张照鹏,等.160例腹腔镜根治性膀胱切除术后淋巴漏的影响因素分析 \=-P<0.001). All patients were cured after conservative treatment including fasting and unobstructed drainage. Conclusion The number of positive lymph nodes and whether lymphatic tissues are clamped with Hemolock after dissection are high risk factors of postoperative lymphatic leakage. Conservative treatment and adequate drainage can achieve satisfactory results. Skillful grasp of operation skills, clamping after lymph node dissection, good knowledge of anatomy and careful operation can prevent occurrence of lymphatic leakage.

Key words: Lymphatic leakage, Bladder cancer, Laparoscopic radical cystectomy, Pelvic lymph node dissection

中图分类号:

R737.14

张照鹏,邢乃栋,张翔,阎磊,徐忠华. 160例腹腔镜根治性膀胱切除术后淋巴漏的影响因素分析[J]. 山东大学学报 (医学版), 2020, 58(1): 67-72.

ZHANG Zhaopeng, XING Naidong, ZHANG Xiang, YAN Lei, XU Zhonghua. Influencing factors of lymphatic leakage after laparoscopic radical cystectomy: an analysis of 160 cases[J]. Journal of Shandong University (Health Sciences), 2020, 58(1): 67-72.

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