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盆腹腔淋巴切除术后淋巴漏的诊治现状

张啸宇 沈杨

张啸宇, 沈杨. 盆腹腔淋巴切除术后淋巴漏的诊治现状[J]. 协和医学杂志, 2020, 11(6): 732-736. doi: 10.3969/j.issn.1674-9081.2020.00.003
引用本文: 张啸宇, 沈杨. 盆腹腔淋巴切除术后淋巴漏的诊治现状[J]. 协和医学杂志, 2020, 11(6): 732-736. doi: 10.3969/j.issn.1674-9081.2020.00.003
ZHANG Xiao-yu, SHEN Yang. The Diagnosis and Treatment of Lymphatic Leakage after Gynecological Pelvic Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 732-736. doi: 10.3969/j.issn.1674-9081.2020.00.003
Citation: ZHANG Xiao-yu, SHEN Yang. The Diagnosis and Treatment of Lymphatic Leakage after Gynecological Pelvic Surgery[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(6): 732-736. doi: 10.3969/j.issn.1674-9081.2020.00.003

盆腹腔淋巴切除术后淋巴漏的诊治现状

doi: 10.3969/j.issn.1674-9081.2020.00.003
基金项目: 

国家自然科学基金 81673130

国家自然科学基金 82072078

详细信息
    通讯作者:

    沈杨  电话:025-83262742,E-mail:shenyang0924@sina.cn

  • 中图分类号: R713;R619

The Diagnosis and Treatment of Lymphatic Leakage after Gynecological Pelvic Surgery

Funds: 

National Natural Science Foundation of China 81673130

National Natural Science Foundation of China 82072078

More Information
  • 摘要: 淋巴漏是妇科盆腔术后常见的并发症,对于存在肥胖、贫血、术中出血过多及淋巴结肿大等高危因素的患者,应给予足够重视。淋巴漏发生后应首选保守治疗,包括禁食、营养支持、药物治疗等; 对于保守治疗不佳的难治性患者,可考虑手术或介入治疗,目前超声引导下结内淋巴管造影术不失为一种可选择的方法。本文回顾盆腹腔淋巴系统的解剖及生理,分析妇科术后淋巴漏的形成原因、高危因素、治疗方法及预防措施,以期为临床医生提供指导和帮助。
    作者贡献:  张啸宇负责文献查询、文章撰写; 沈杨负责文章审校。
    利益冲突:  无
  • 图  1  女性盆腹腔淋巴分布示意图

  • [1] 曹晖, 赵恩昊.胃手术后淋巴漏和乳糜漏原因及防治[J].中国实用外科杂志, 2017, 37:355-358. http://qikan.cqvip.com/Qikan/Article/Detail?id=671269039

    Cao H, Zhao EH. Prevention and management of lymph-orrhea or chylorrhea after gastric surgeries[J].Zhongguo Shi Yong Wai Ke Za Zhi, 2017, 37: 355-358. http://qikan.cqvip.com/Qikan/Article/Detail?id=671269039
    [2] Besselink MG, van Rijssen LB, Bassi C, et al. Definition and classification of chyle leak after pancreatic operation: a consensus statement by the International Study Group on Pancreatic Surgery[J]. Surgery, 2017, 161:365-372. doi:  10.1016/j.surg.2016.06.058
    [3] Abu Hilal M, Layfield DM, Di Fabio F, et al. Postoperative chyle leak after major pancreatic resections in patients who receive enteral feed: risk factors and management options[J]. World J Surg, 2013, 37:2918-2926. doi:  10.1007/s00268-013-2171-x
    [4] Lee YS. Single-port laparoscopic transperitoneal infrarenal para-aortic lymphadenectomy as part of staging operation for early ovarian cancer and high grade endometrial cancer[J].J Gynecol Oncol, 2016, 27:e32. doi:  10.3802/jgo.2016.27.e32
    [5] Inoue M, Nakatsuka S, Yashiro H, et al. Lymphatic Intervention for Various Types of Lymphorrhea: Access and Treatment[J].Radiographics, 2016, 36:2199-2211. doi:  10.1148/rg.2016160053
    [6] 李培全, 刘青, 刘开江, 等.妇科恶性肿瘤腹腔镜淋巴结清扫术后淋巴漏的影响因素及治疗方法[J].中国内镜杂志, 2018, 24:43-49.

    Li PQ, Liu Q, Liu KJ, et al. Risk factors and treatment of lymph leakage after laparoscopic gynecological malignant tumor lymph node dissection[J]. Zhongguo Nei Jing Za Zhi, 2018, 24:43-49.
    [7] Thiel FC, Parvanta P, Hein A, et al. Chylous ascites after lymphadenectomy for gynecological malignancies[J]. J Surg Oncol, 2016, 114:613-618. doi:  10.1002/jso.24354
    [8] Solmaz U, Turan V, Mat E, et al. Chylous ascites following retroperitoneal lymphadenectomy in gynecologic malignancies: incidence, risk factors and management[J]. Int J Surg, 2015, 16:88-93. doi:  10.1016/j.ijsu.2015.02.020
    [9] 郭书焕, 韩丽萍, 刘韬, 等.腹腔镜淋巴结清扫术后并发乳糜漏的防治[J].中国内镜杂志, 2014, 20:1284-1288.

    Guo SH, Han LP, Liu T, et al. Prevention of chylous leakage after laparoscopic lymphadenectomy[J]. Zhongguo Nei Jing Za Zhi, 2014, 20: 1284-1288.
    [10] 张小文, 杨劼, 刘文国, 等.胸腔镜下胸导管结扎术的应用解剖[J].中国临床解剖学杂志, 2014, 32:264-268.

    Zhang XW, Yang J, Liu WG, et al. Applied anatomic study of video-assisted thoracoscopic ligation of thoracic duct[J]. Zhongguo Lin Chuang Jie Pou Xue Za Zhi, 2014, 32:264-268.
    [11] 梁海燕, 房青, 彭亮, 等.腹腔镜治疗妇科恶性肿瘤术后淋巴漏的临床分析[J].中日友好医院学报, 2011, 25:204-206. doi:  10.3969/j.issn.1001-0025.2011.04.004

    Liang HY, Fang Q, Peng L, et al. Clinical analysis of the lymphorrhagia after laparoscopic gynecologic surgery of tumors[J]. Zhong Ri You Hao Yi Yuan Xue Bao, 2011, 25: 204-206. doi:  10.3969/j.issn.1001-0025.2011.04.004
    [12] 赵宇清, 谭鑫, 胡卫国.腹腔镜下淋巴结清扫术后并发淋巴漏的临床分析[J].现代妇产科进展, 2013, 22:449-452. http://www.cnki.com.cn/Article/CJFDTotal-XDFC201306006.htm

    Zhao YQ, Tan X, Hu WG. Clinical analysis of the lymphorrhagia after laparoscopic lymphadenectomy in gyne-cologic malignancies[J].Xian Dai Fu Chan Ke Jin Zhan, 2013, 22: 449-452. http://www.cnki.com.cn/Article/CJFDTotal-XDFC201306006.htm
    [13] Huang Q, Ge BJ, Liu LM, et al.Successful management of chylous ascites with total parenteral nutrition, somatostatin, and fibrin glue[J].Chin Med J (Engl), 2007, 120: 1847-1849. doi:  10.1097/00029330-200710020-00024
    [14] Laccourreye O, Espinoza S, Mukundian S, et al.Preven-tion and cure of lymphorrhea and lymphocele after cervical lymph-node surgery[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2013, 130: 229-232. doi:  10.1016/j.anorl.2012.05.004
    [15] Mukerji AN, Tseng E, Karachristos A, et al. Chylous ascites after liver transplant: case report and review of literature[J].Exp Clin Transplant, 2013, 11: 367-374. doi:  10.6002/ect.2012.0203
    [16] Weniger M, D'Haese JG, Angele MK, et al. Treatment options for chylous ascites after major abdominal surgery: a systematic review[J]. Am J Surg, 2016, 211: 206-213. doi:  10.1016/j.amjsurg.2015.04.012
    [17] Creavin B, Ryan E, Martin ST, et al. Organ preservation with local excision or active surveillance following chemoradiotherapy for rectal cancer[J]. Br J Cancer, 2017, 116: 169-174. doi:  10.1038/bjc.2016.417
    [18] Kawasaki R, Sugimoto K, Fujii M, et al. Therapeutic effectiveness of diagnostic lymphangiography for refractory postoperative chylothorax and chylous ascites: correlation with radiologic findings and preceding medical treatment[J].AJR Am J Roentgenol, 2013, 201:659-666. doi:  10.2214/AJR.12.10008
    [19] 刘晓娜, 王泽娟. Denver管腹腔-静脉分流术治疗乳糜性腹水患者的护理[J].护理学杂志, 2014, 29: 30-32.

    Liu XN, Wang ZJ. Nursing care of patients with chylous ascites treated with Denver peritoneovenous shunting[J]. Hu Li Xue Za Zhi, 2014, 29:30-32.
    [20] Kong TW, Chang SJ, Kim J, et al. Risk factor analysis for massive lymphatic ascites after laparoscopic retroperitonal lymphadenectomy in gynecologic cancers and treatment using intranodal lymphangiography with glue embolization[J]. J Gynecol Oncol, 2016, 27:e44. doi:  10.3802/jgo.2016.27.e44
    [21] Inoue M, Nakatsuka S, Yashiro H, et al. Lymphatic Intervention for Various Types of Lymphorrhea:Access and Treatment[J]. Radiographics, 2016, 36: 2199-2211. doi:  10.1148/rg.2016160053
    [22] Kim CJ, Yeatman TJ, Coppola D, et al. Local excision of T2 and T3 rectal cancers after downstaging chemoradiation[J].Ann Surg, 2001, 234:352-358. doi:  10.1097/00000658-200109000-00009
    [23] Inoue M, Kojima M, Akiyoshi T, et al. Lymphatic intervention for various kinds of lymphorrhea[J]. J Vasc Intervent Radiol, 2015, 2: 201-204.
    [24] Güngördük K, Güngördükö C, Ozdemir IA, et al. Does BLOODCARE powder prevent postoperative chylous ascites after lymphadenectomy for gynecological malignancies?[J].Int J Gynecol Cancer, 2017, 27:1979-1982. doi:  10.1097/IGC.0000000000001093
    [25] Phang PT, Wang X. Current controversies in neoadjuvant chemoradiation of rectal cancer[J].Surg Oncol Clin N Am, 2014, 23:79-92. doi:  10.1016/j.soc.2013.09.008
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  • 被引次数: 0
出版历程
  • 收稿日期:  2019-06-10
  • 录用日期:  2020-02-27
  • 网络出版日期:  2020-08-11
  • 刊出日期:  2020-11-30

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