胃癌根治术后合并淋巴漏43例临床分析

目的：回顾性分析根治性胃癌手术后合并腹腔淋巴漏的相关因素并就其临床经过及处理方法予以初探。方法-对我科室2009年1月至2010年7月间408例胃癌根治术后43例（10．5％）发生淋巴漏患者的临床资料进行回顾性分析。结果：单因素分析提示，T分期，N分期，TNM分期与淋巴漏发生相关。多因素分析提示与淋巴漏发生相关的独立因素有术式、淋巴结廓清程度、淋巴结清扫数目。淋巴漏的发生与性别、年龄、营养风险评估无关。使用超声刀、生物胶的病例淋巴漏发生率较低，但差异无统计学显著性意义。43例中38例经非手术治疗治愈，5例因非手术治疗无效行手术探查引流区结扎，其中4例术后痊愈，1例术后死亡。结论：腹腔淋巴漏是胃癌根治术后重要并发症之一，其发生与手术方式、淋巴结清扫程度及淋巴结清扫数目有关。多数淋巴漏通过肠外营养支持，生长抑素治疗后可自愈。保守治疗无效时手术治疗可能有益。

Clinical Investigation of Lymphorrhagia after Radical Operation of Gastric Cancer, a report of 43 Cases

Objective： To investigate the clinicopathological factors correlated with abdominal lymphorrhagia after radical surgery for gastric cancer. The clinical courses and treatments of lymphorrhagia were also studied. Methods： The clinical data of 408 patients un- dergoing radical gastrectomy from January 2009 to July 2010 were analyzed. Among them, 43 patients were diagnosed of lymphorrhagia （10.5%）. The correlation between the clinicopathological factor and lymphorrhagia were analyzed. Results： Univariate analysis showed that TNM, T factor and N factor were correlated with the occurrence of lymphorrhagia. Multivariate analysis indicated that the incidence of lymphorrhagia was significantly correlated with operation type, lymphadenectomy extent, number of lymph node dissected. It was not significantly correlated with sex, age, nutritional risk. The use of ultrasonic scalpel and biological glue tended to associate with a lower incidence of lymphorrhagia, which was not statistically significant. The 38 of 43 lymphorrhagia cases were cured by non-surgical treat- ment including parenteral nutrition and somatostatin. Five cases who were invalid by non-surgical treatment underwent surgical explo- ration and suture. Among them, 4 patients recovered and 1 patient died. Conclusion： Abdominal lymphorrhagia after radical gastric can- cer operation was one of the serious complications. It was associated with the operation type, lymphadenectomy extent and number of lymph node dissection. Most cases could gain cure by the treatment including parenteral nutrition support and somatostatin. Surgery could be beneficial in the failed conservative treaments.