摘要
目的探讨腹腔镜下膀胱根治性切除术中盆腔淋巴结清扫采用不同操作方式对术后淋巴瘘的影响。方法自2009年1月至2013年1月北京大学人民医院收治的行腹腔镜根治性膀胱切除术并盆腔淋巴结清扫术的60例膀胱癌患者。盆腔淋巴结清扫范围为标准的切除范围。患者随机分为A、B两组,每组30例。A组患者应用超声刀结合血管分离钳行淋巴结清扫术,术后盆腔放置引流管引流。B组患者同样应用超声刀结合血管分离钳行淋巴结清扫术,但是切断盆壁附着淋巴管之前采用Hem-o-Lock钳夹。术后同样放置盆腔引流管。对比两组患者术后淋巴瘘、住院时间等相关参数情况。结果两组患者手术均顺利完成。所有患者行淋巴结清扫术后均未输血,患者的盆腔引流管在引流量持续24 h少于20 ml后拔除。A组患者盆腔引流管留置时间平均4-20（8.6±4.4）d,3 d后检测盆腔引流液肌酐及乳糜试验,其中14例引流液提示为淋巴液漏出,14例患者拔除引流管时间为7-20（11.3±2.9）d,平均引流液量为830-2 400（1 100±210）ml/d。B组患者盆腔引流管留置平均时间3-7（4.7±1.7）d,3 d后检测引流液肌酐及乳糜试验,其中7例引流液检查提示为淋巴液漏出,此7例患者拔除引流管时间为4-7（5.2±1.6）d,平均引流液量为360-880（420±160）ml/d。结论 腹腔镜下盆腔淋巴结清扫术手术能够做到精细操作,对较大的淋巴管采取预防性的结扎,对减少术后淋巴瘘可发挥重要作用。
Objective This study is to investigate the influence of lymphatic fistula in patients undergoing radical cystectomy（RC） and lymph node dissection（LND） using different mode of operation for bladder cancer. Methods Prospectively collected data of 60 patients who underwent RC and standard LND for urothelial carcinoma of the bladder between 2009 and 2013 were examined. Patients were divided into two groups at random. In group A, 30 patients underwent standard LND with ultrasound knife and separating forceps. In group B, 30 patients also underwent standard LND, in additional with Hem-o-Lock for ligature thick lymphatic duct from pelvic wall. The drainage tube was put down to pelvic cavity postoperative in two groups. Compared the data such as lymphatic fistula, the hospitalization time of patients in two groups. Results Operations were successfully completed of all patients. After standard LND no patients had blood transfusion. The pelvic drainage tube were removed after the drainage volume were less than 20 ml for 24 hours. The indwelling time of pelvic drainage tube of group A were（8.6±4.4）days（4-20 days）, 3 days after the detection of pelvic drainage fluid creatinine and chyle test, of which 14 cases showed drainage fluid as lymphatic fistula, drain removal time of these 14 cases were（11.3±2.9）days（7-20 days）, the average drainage volume was（1 100±210）ml/d（830-2 400 ml/d）. The indwelling time of pelvic drainage tube of group B were（4.7±1.7）days（3-7 days）, 3 days after the detection of drainage fluid creatinine and chyle test, including 7 cases of drainage fluid examination showed as lymph fluid leaks, the extraction of drainage tube time was（5.2±1.6）days（4-7 days）, the average drainage volume was（420±160）ml/d（360-880 ml/d）. Conclusions Pelvic lymphadenectomy during radical cystectomy by laparoscopic can achieve fine result. Preventive ligation on larger lymphatic duct can play an important role in reducing lymphatic fistula after operation.
出处
《中华临床医师杂志（电子版）》
CAS
2015年第6期33-36,共4页
Chinese Journal of Clinicians(Electronic Edition)
关键词
膀胱肿瘤
淋巴瘘
淋巴结清扫术
腹腔镜检查
并发症
Urinary bladder neoplasms
Lymphatic fistula
Lymph node dissection
Laparoscopy
Complications
