目的总结19例胃癌根治术后合并淋巴瘘的诊治经验。 方法对我院2001年1月至2010年3月期间204例胃癌根治术后19例发生淋巴瘘患者的临床资料进行回顾性分析。 结果19例中15例经非手术治疗治愈，4例因非手术治疗无效行手术探查，其中2例术后痊愈，另2例分别于术后第3天和第6天再次并发淋巴瘘，最终致全身多器官功能衰竭而死亡。 本组淋巴瘘发生率与患者性别、年龄及术前是否化疗无关（Pgt;0.05），但第7、8a、9和16组淋巴结同时有转移者高于无转移者、行D2+手术者高于行D2手术者、使用超声刀者高于未使用者、Ⅱ及Ⅲ期高于Ⅰ期（Plt;0.01），未使用生物蛋白胶者高于使用者、行早期肠内营养者高于晚期肠内营养者、胃中上部肿瘤高于胃下部肿瘤（Plt;0.05）。 TPN加用生长抑素及生长激素者腹腔引流量为（330±40） ml/d，均明显少于单用TPN 〔(750±140) ml/d〕及TPN加用生长抑素者〔(450±40) ml/d〕，Plt;0.01和Plt;0.05，后两者比较其差异也有统计学意义（Plt;0.05）。 TPN加用生长抑素及生长激素患者淋巴瘘的愈合时间为（13.1±1.5） d，较完全TPN的（25.6±2.1） d及TPN加用生长抑素的（18.3±7.1） d缩短，Plt;0.05，后两者比较的差异也有统计学意义（Plt;0.05）。 结论胃癌根治术中可靠结扎淋巴管、避免过度扩大淋巴结清扫范围以及避免早期的肠内营养对预防术后淋巴瘘极为重要。
ObjectiveTo investigate the necessity and value of subcutaneous suction drainage in the prevention of fat liquefaction of postoperative abdominal vertical incision for obese patients. MethodsThree hundred and fortytwo obese patients underwent abdominal vertical incision from February 2008 to October 2010 were randomly divided into indwelling tube group and noindwelling tube group in our department of general surgery and obstetrics and gynecology. Agrade healing rate, the incidences of fat liquefaction and incision complications, mean healing time of incision, patient satisfaction, foreign body sensation, and direct medical costs were evaluated. ResultsThree hundred and twentyeight cases were included according to the inclusion and exclusion criteria, 165 patients in the indwelling tube group and 163 patients in the noindwelling tube group. There were not significant differences of age, gender, fat thickness, surgical time, incision length, and BMI between two groups (Pgt;0.05). The incidence of foreign body sensation of the no-indwelling tube group was less than that of the indwelling tube group 〔3.7% (6/163) versus 50.3% (83/165 )〕, Plt;0.05. The score of patient satisfaction of the no-indwelling tube group was higer than that of the indwelling tube group 〔(9.2±2.8) points versus (6.8±1.7) points〕, Plt;0.05. There were no significant differences in incidences of fat liquefaction and incision complications, A-grade healing rate, mean healing time of incision, and direct medical costs between two groups (Pgt;0.05). ConclusionIt’s unnecessary to indwell a conventional suction drainage tube to prevent fat liquefaction of the obese patient with vertical abdominal incision.