血管手术后腹股沟部淋巴瘘的原因和防治

目的：分析血管手术后发生腹股沟部淋巴瘘的原因和防治方法。方法：对1238例有腹股沟部切口的动静脉手术病人进行了回顾性调研，记录这些病人的一般情况、术中所见、以前有无腹股沟部手术史、淋巴并发症的处理方法、术后伤口愈合情况、病人住院时间和费用等。结果：36例病人发生了腹股沟部淋巴瘘，其中6例为股部动脉瘤或假性动脉瘤手术，7例为腹股沟部再手术者，15例发生于手术中见腹股沟有明显肿大的淋巴结，14例发生于下肢小腿部或脚趾部有溃疡或坏死灶，5例见于腹股沟伤口感染（3例为肥胖者）。术中广泛解剖（动脉瘤和再手术者）、腹股沟有明显肿大的淋巴结和肢体有溃疡或坏死灶者发生淋巴瘘的比率均明显增加（P＜0．01）。发生淋巴瘘的病人的住院时间和费用较伤口一期愈合者明显延长和增加（P＜0．01）。其中32例病人进行了保守治疗，4例病人术后早期采用再次手术治疗。结论：血管手术后腹股沟部位淋巴瘘的发生可能与腹股沟部进行广泛解剖分离、受损的淋巴管数量、管径、淋巴液回流量和是否感染、炎症等有关。血管手术后腹股沟部位淋巴并发症的重点在于预防；如淋巴瘘持续存在且淋巴引流量较大者最好早期再次行手术治疗。

The Pathogenesis, Prophylaxis and Treatment of Groin Lymphatic Fistula after Vascular Operations

Objective: To investigate the Pathogenesis, prophylaxis and treatment of groin lymphatic fistula (GLF) after vascular operations. Methods: A retrospective review of a vascular operation(s) registry for 6 years identified 1 238 arterial and/or venous operations requiring a groin incision. Data collected included general clinical conditions, operative procedure(s), previous groin operative procedures, method(s) of treatment of groin lymphatic fistula(s), postoperative wound complications, and duration of hospitalization and expenses of treatment. Results: GLF occurred in 36 patients: repair of femoral aneurysm or peseudoaneurysm in 6 cases, previous groin operative procedure(s) in 7, enlarged lymph node(s) witnessed in 15, leg ulcerations in 14 and groin wound infection in 5.The occurrence of GLF was related to extensive dissection, the number and caliber of disrupted lymphatic vessels, infection and inflammation(P<0.01). The duration of hospitalization and the expenses of treatment were increased in GLF patients (P<0.01). Thirty-two cases of GLF were treated by conservative approaches and 4 GLF by early reoperation. Conclusions: The occurrence of GLF after vascular operation(s) may be related to extensive dissection, the number and caliber of disrupted lymphatic vessels, infection and inflammation. Prophylaxis of GLC should be preferred. The treatment for GLC is to be individualized, early reoperation is advised should the lymphocutaneous fislula be persistent and the quantity of drainage be noticeable.