腹腔镜辅助根治性切除术对SiewertⅡ型、Ⅲ型胃食管结合部癌患者治疗后乳糜漏的危险因素分析  

The curative effects of laparoscopic assisted radical resection operation on Siewert type Ⅱ and type Ⅲ gastric esophagus cancer and the risk factors of chyle leakage after the operation

作　　者：郭丹 郭银燕[1] 庆琳琳 赵晓志[1] 尚杰[1] 王怀唐 GUO Dan;GUO Yinyan;QING Linlin(Department of Digestive System Diseases,Haidian District Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院消化内科,100080

出　　处：《河北医药》2018年第23期3607-3609,共3页Hebei Medical Journal

摘　　要：目的探讨腹腔镜辅助根治性切除术对SiewertⅡ型、Ⅲ型胃食管结合部癌患者治疗后乳糜漏的危险因素并进行分析。方法选取2014年2月至2016年2月接受腹腔镜辅助根治性切除术治疗的SiewertⅡ型、Ⅲ型胃食管结合部癌患者120例。按照患者术后是否发生乳糜漏分为乳糜漏组(59例)和未糜漏组(61例)。比较2组患者各项资料,并进行多因素非条件Logistic回归分析。结果乳糜漏组术前低蛋白血症发生率、术前辅助化疗率、转移淋巴结数以及NO. 9淋巴结转移率均显著高于非乳糜漏组,差异均有统计学意义(均P <0. 05)。经多因素Logistic回归分析,影响患者术后发生乳糜漏独立危险因素分别为术前低蛋白血症(OR=2. 412,P=0. 000)、转移淋巴结数(OR=1. 583,P=0. 000)、术前辅助化疗(OR=3. 933,P=0. 000)及NO. 9淋巴结转移(OR=2. 094,P=0. 000)。结论腹腔镜辅助根治性切除术对SiewertⅡ型、Ⅲ型胃食管结合部癌患者治疗后乳糜漏的危险因素分别是术前低蛋白血症、转移淋巴结数、术前辅助化疗及NO. 9淋巴结转移,术中应给予患者针对性预防措施,避免乳糜漏的发生。Objective To evaluate the effects of laparoscopic assisted radical resection operation on Siewert typeⅡand typeⅢgastric esophagus cancer,and to analyze the risk factors of chyle leakage after the operation.Methods A total of 120 patients with Siewert typeⅡand typeⅢgastric esophagus cancer who underwent laparoscopic assisted radical resection operation in our hospital from February 2014 to February 2016 were enrolled in the study.According to whether the patients had chyle leakage after the operation,they were divided into chyle leakage group(n=59)and non-chyle leakage group(n=61).The clinical data were compared between the two groups,moreover,multi factor non conditional logistic regression analysis was performed.Results The incidence rate of preoperative hypoalbuminemia,preoperative adjuvant chemotherapy rate,metastasis lymph node number and No.9 lymph node metastasis rate in chyle leakage group were significantly higher than those in non-chyle leakage group(P<0.05).The multivariate logistic regression analysis showed that the independent risk factors affecting the postoperative occurrence of chyle leakage were preoperative low protein hyperlipidemia(OR=2.412,P<0.01)and lymph node metastasis number(OR=1.583,P<0.01),preoperative adjuvant chemotherapy(OR=3.933,P<0.01)and No.9 lymph node metastasis(OR=2.094,P<0.01).Conclusion The risk factors of chyle leakage after laparoscopic assisted radical resection operation in treatment of Siewert typeⅡand typeⅢgastric esophagus cancer are preoperative hypoproteinemia,lymph node metastasis number,preoperative adjuvant chemotherapy and No.9 lymph node metastasis,it is necessary to take preventive measures during operation to avoid the occurrence of chyle leakage.

关 键 词：根治性切除术 乳糜漏 淋巴结转移 危险因素 

分 类 号：R735.2[医药卫生—肿瘤]