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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。
OBJECTIVE: To retrospectively analyze the related factors of peritoneal lymphatic leakage after radical operation of gastric cancer and to discuss its clinical approach and treatment. Methods: A retrospective analysis was performed on the clinical data of 408 cases of lymphopexy in 43 cases (10.5%) after radical gastrectomy in our department from January 2009 to July 2010. Results: Univariate analysis showed that T stage, N stage and TNM stage were related to lymphoid leakage. Multivariate analysis showed that the independent factors associated with the occurrence of lymphatic leakage were surgical procedures, degree of lymph node dissection, and the number of lymph node dissections. The occurrence of lymphatic leak has nothing to do with gender, age, nutrition risk assessment. The use of ultrasonic scalpel, the incidence of cases of biological glue lymphoblasts lower, but the difference was not statistically significant. Among the 43 cases, 38 cases were cured by non-surgical treatment and 5 cases were ineffective due to non-surgical treatment. Ligation was performed in the drainage area, of which 4 cases recovered and 1 case died after operation. Conclusions: Abdominal lymphatic leakage is one of the most important complications after radical operation of gastric cancer. The occurrence of this disease is related to the operation mode, the degree of lymph node dissection and the number of lymph node dissection. Most lymphatic drainage through parenteral nutrition support, somatostatin treatment can be self-healing. Surgical treatment may be beneficial if conservative treatment is not effective.