• 四川安岳縣中醫(yī)醫(yī)院外一科(安岳 642350);

目的 探討大隱靜脈高位結(jié)扎及剝脫術(shù)后腹股溝切口淋巴瘺發(fā)生的原因和防治方法。方法 回顧性分析我院收治的120例(186條患肢)行大隱靜脈高位結(jié)扎及剝脫術(shù)者中術(shù)后發(fā)生腹股溝切口淋巴瘺患者的臨床資料,并對(duì)相關(guān)文獻(xiàn)進(jìn)行復(fù)習(xí)。結(jié)果 大隱靜脈高位結(jié)扎及剝脫術(shù)后腹股溝切口淋巴瘺發(fā)生率為4.3%(8/186)。2例單側(cè)腹股溝切口淋巴瘺患者擴(kuò)創(chuàng)后予以碘伏紗布填塞創(chuàng)面,于第20天及第23天后淋巴瘺閉合,再行切口二期縫合,7 d后拆線; 3例雙側(cè)腹股溝切口淋巴瘺患者切口創(chuàng)面予以醫(yī)用膠噴灑后碘伏紗布填塞,3 d后淋巴瘺全部閉合,切口二期縫合、加壓包扎后7 d拆線。切口均愈合良好。結(jié)論 對(duì)腹股溝區(qū)股根部不恰當(dāng)?shù)膹V泛解剖及淋巴結(jié)切除的不規(guī)范與大隱靜脈高位結(jié)扎及剝脫術(shù)后腹股溝切口淋巴瘺的發(fā)生密切相關(guān)。術(shù)前對(duì)大隱靜脈準(zhǔn)確定位,術(shù)中仔細(xì)操作、避免廣泛剝離、避免切除腫大淋巴結(jié)是預(yù)防腹股溝切口淋巴瘺的有效措施。淋巴瘺發(fā)生后予以醫(yī)用膠封堵是有效的補(bǔ)救措施。

引用本文: 劉丹,方海龍,劉華. 大隱靜脈高位結(jié)扎及剝脫術(shù)后腹股溝切口淋巴瘺臨床分析及文獻(xiàn)回顧. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(12): 1312-1313. doi: 復(fù)制

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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. 錢澤京, 王龍昌, 曲志華. 腹股溝區(qū)淋巴瘺16例治療體會(huì) [J]. 山東醫(yī)藥, 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. 陳中皓, 龔亦群, 呂杰捷. 纖維蛋白封閉劑預(yù)防血管外科手術(shù)并發(fā)腹股溝淋巴瘺的回顧性分析 [J]. 上海醫(yī)藥, 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. 1. 吳在德. 外科學(xué) [M]. 第6版. 北京: 人民衛(wèi)生出版社, 2003: 640-641.
  2. 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. 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. 4. 韓良愉. 淋巴造影術(shù) [J]. 實(shí)用外科雜志, 1988; 8(10): 556-568.
  5. 5. 鄭扶民. 重視淋巴外科的發(fā)展 [J]. 實(shí)用外科雜志, 1993; 13(2): 67-68.
  6. 6. 陸信武, 蔣米爾. 血管手術(shù)后腹股溝部淋巴瘺的原因和防治 [J]. 外科理論與實(shí)踐, 2002; 7(3): 218-220.
  7. 7. 劉靜, 鄒耀強(qiáng), 周天保. 3例大隱靜脈曲張術(shù)后淋巴漏的診治體會(huì) [J]. 中國普外基礎(chǔ)與臨床雜志, 2002; 9(4): 271.
  8. 8. 凌斌. 大隱靜脈高位結(jié)扎剝脫術(shù)并發(fā)淋巴瘺一例 [J]. 臨床外科雜志, 2005; 13(5): 310.
  9. 9. 郭建斌, 賈學(xué)民. 醫(yī)源性淋巴管漏的治療 [J]. 中國修復(fù)重建外科雜志, 2006; 20(9): 958-959.
  10. 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. 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. 12. 錢澤京, 王龍昌, 曲志華. 腹股溝區(qū)淋巴瘺16例治療體會(huì) [J]. 山東醫(yī)藥, 2007; 47(18): 25.
  13. 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. 14. 陳中皓, 龔亦群, 呂杰捷. 纖維蛋白封閉劑預(yù)防血管外科手術(shù)并發(fā)腹股溝淋巴瘺的回顧性分析 [J]. 上海醫(yī)藥, 2004; 25(8): 361-362.
  15. 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.