Analysis and Review of Literature to Lymphatic Fistula in Groin Incision after Great Saphenous Vein High Ligation and Stripping_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 刘丹 , 方海龙 , 刘华

Corresponding author：

刘丹, Email: 380589895@qq.com

Keywords：

大隐静脉高位结扎及剥脱术; 腹股沟切口淋巴瘘; 医用胶

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目的探讨大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生的原因和防治方法。方法回顾性分析我院收治的120例(186条患肢)行大隐静脉高位结扎及剥脱术者中术后发生腹股沟切口淋巴瘘患者的临床资料，并对相关文献进行复习。结果大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘发生率为4.3%（8/186）。2例单侧腹股沟切口淋巴瘘患者扩创后予以碘伏纱布填塞创面，于第20天及第23天后淋巴瘘闭合，再行切口二期缝合，7 d后拆线； 3例双侧腹股沟切口淋巴瘘患者切口创面予以医用胶喷洒后碘伏纱布填塞，3 d后淋巴瘘全部闭合，切口二期缝合、加压包扎后7 d拆线。切口均愈合良好。结论对腹股沟区股根部不恰当的广泛解剖及淋巴结切除的不规范与大隐静脉高位结扎及剥脱术后腹股沟切口淋巴瘘的发生密切相关。术前对大隐静脉准确定位，术中仔细操作、避免广泛剥离、避免切除肿大淋巴结是预防腹股沟切口淋巴瘘的有效措施。淋巴瘘发生后予以医用胶封堵是有效的补救措施。

Citation： 刘丹,方海龙,刘华. Analysis and Review of Literature to Lymphatic Fistula in Groin Incision after Great Saphenous Vein High Ligation and Stripping. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(12): 1312-1313. doi: Copy

1.	吴在德. 外科学 [M]. 第6版. 北京：人民卫生出版社, 2003: 640-641.
2.	Tyndall SH, Shepard AD, Wilczewski JM, et al. Groin lymphatic complications after arterial reconstruction [J]. J Vasc Surg, 1994; 19(5): 858-863.
3.	Schwartz MA, Schanzer H, Skladany M, et al. A comparison of conservative therapy and early selective ligation in the treatment of lymphatic complications following vascular procedures [J]． Am J Surg, 1995; 170(2): 206-208.
4.	韩良愉. 淋巴造影术 [J]. 实用外科杂志, 1988; 8（10）： 556-568.
5.	郑扶民. 重视淋巴外科的发展 [J]. 实用外科杂志， 1993; 13（2）： 67-68.
6.	陆信武，蒋米尔. 血管手术后腹股沟部淋巴瘘的原因和防治 [J]. 外科理论与实践, 2002; 7（3）: 218-220.
7.	刘静，邹耀强，周天保. 3例大隐静脉曲张术后淋巴漏的诊治体会 [J]. 中国普外基础与临床杂志， 2002; 9（4）: 271.
8.	凌斌. 大隐静脉高位结扎剥脱术并发淋巴瘘一例 [J]. 临床外科杂志, 2005; 13（5）： 310.
9.	郭建斌，贾学民. 医源性淋巴管漏的治疗 [J]. 中国修复重建外科杂志， 2006; 20（9）： 958-959.
10.	Jones TR, Carlisle MR, Hofmann LV, et al. Lymphoscintigraphy in the diagnosis of lymphatic leak after surgical repair of femoral artery injury [J]． Clin Nucl Med, 2001; 26(1): 14-17.
11.	Logmans A, Kruyt RH, de Bruin HG, et al. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study [J]． Gynecol Oncol, 1999; 75(3): 323-327.
12.	钱泽京，王龙昌，曲志华. 腹股沟区淋巴瘘16例治疗体会 [J]. 山东医药, 2007; 47（18）： 25.
13.	Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer [J]. Scand J Plast Reconstr Surg Hand Surg, 1997; 31(2): 137-143.
14.	陈中皓, 龚亦群, 吕杰捷. 纤维蛋白封闭剂预防血管外科手术并发腹股沟淋巴瘘的回顾性分析 [J]. 上海医药, 2004; 25（8）: 361-362.
15.	Davidson BR, Burnett S, Javed MS， et al. Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy [J]． Br J Surg, 2000; 87(6): 790-795.

1. 吴在德. 外科学 [M]. 第6版. 北京：人民卫生出版社, 2003: 640-641.
2. Tyndall SH, Shepard AD, Wilczewski JM, et al. Groin lymphatic complications after arterial reconstruction [J]. J Vasc Surg, 1994; 19(5): 858-863.
3. Schwartz MA, Schanzer H, Skladany M, et al. A comparison of conservative therapy and early selective ligation in the treatment of lymphatic complications following vascular procedures [J]． Am J Surg, 1995; 170(2): 206-208.
4. 韩良愉. 淋巴造影术 [J]. 实用外科杂志, 1988; 8（10）： 556-568.
5. 郑扶民. 重视淋巴外科的发展 [J]. 实用外科杂志， 1993; 13（2）： 67-68.
6. 陆信武，蒋米尔. 血管手术后腹股沟部淋巴瘘的原因和防治 [J]. 外科理论与实践, 2002; 7（3）: 218-220.
7. 刘静，邹耀强，周天保. 3例大隐静脉曲张术后淋巴漏的诊治体会 [J]. 中国普外基础与临床杂志， 2002; 9（4）: 271.
8. 凌斌. 大隐静脉高位结扎剥脱术并发淋巴瘘一例 [J]. 临床外科杂志, 2005; 13（5）： 310.
9. 郭建斌，贾学民. 医源性淋巴管漏的治疗 [J]. 中国修复重建外科杂志， 2006; 20（9）： 958-959.
10. Jones TR, Carlisle MR, Hofmann LV, et al. Lymphoscintigraphy in the diagnosis of lymphatic leak after surgical repair of femoral artery injury [J]． Clin Nucl Med, 2001; 26(1): 14-17.
11. Logmans A, Kruyt RH, de Bruin HG, et al. Lymphedema and lymphocysts following lymphadenectomy may be prevented by omentoplasty: A pilot study [J]． Gynecol Oncol, 1999; 75(3): 323-327.
12. 钱泽京，王龙昌，曲志华. 腹股沟区淋巴瘘16例治疗体会 [J]. 山东医药, 2007; 47（18）： 25.
13. Brorson H, Svensson H. Complete reduction of lymphoedema of the arm by liposuction after breast cancer [J]. Scand J Plast Reconstr Surg Hand Surg, 1997; 31(2): 137-143.
14. 陈中皓, 龚亦群, 吕杰捷. 纤维蛋白封闭剂预防血管外科手术并发腹股沟淋巴瘘的回顾性分析 [J]. 上海医药, 2004; 25（8）: 361-362.
15. Davidson BR, Burnett S, Javed MS， et al. Experimental study of a novel fibrin sealant for achieving haemostasis following partial hepatectomy [J]． Br J Surg, 2000; 87(6): 790-795.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Analysis and Review of Literature to Lymphatic Fistula in Groin Incision after Great Saphenous Vein High Ligation and Stripping

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