Analysis Of Influencing Factors Of Postoperative Lymphatic Leakage In Patients With Gynecological Malignant Tumor

Objective: To investigate the influencing factors of lymphatic leakage in patients with gynecological malignant tumors after lymph node dissection(pelvic lymphadenectomy ±para-aortic lymphadenectomy),and to study the role of these factors in lymphatic leakage.to provide reference basis for the prevention of postoperative lymphatic leakage in gynecological malignant tumors.Methods: The clinical data of 650 patients who underwent gynecological malignant tumor radical surgery(or tumor cell reduction)+ lymph node dissection(pelvic lymph node dissection ±para-aortic lymphadenectomy)in the affiliated Cancer Hospital of Guangxi Medical University from December 2018 to December 2020 were analyzed retrospectively.the patients were divided into lymphatic leakage group and non-lymphatic leakage group according to the occurrence of lymphatic leakage after operation.the clinical data included: age: BMI(Body Mass Index),neoadjuvant chemotherapy,mode of operation,intraoperative blood loss,intraoperative blood transfusion,hypertension,diabetes,thyroid disease,hemoglobin,albumin,prealbumin level before and after operation,lymph node number,lymph node metastasis,lymph node dissection scope,pathological type,tumor stage.According to different data types,χ 2test and nonparametric test were selected for univariate analysis,multivariate Logistic regression model was selected for multivariate analysis,and maximum likelihood ratio backward step selection method was used to explore the relationship between these variables and postoperative lymphatic leakage.Results: 1.Among the 650 patients included in the study,67 cases had postoperative lymphatic leakage,and the incidence rate of lymphatic leakage was 10.31%.In univariate analysis,there were significant differences in intraoperative bleeding,intraoperative blood transfusion,preoperative Prealbumin(p < 0.05)and postoperative Albumin(p < 0.05).Multivariate analysis showed that the mode of operation,postoperative Hemoglobin were associated with postoperative lymphatic leakage,and intraoperative blood loss and postoperative low prealbumin were the risk factors of postoperative lymphatic leakage.2.All patients with postoperative lymphatic leakage were improved after conservative treatment such as low-fat and high-protein diet,supplementation of albumin,diuresis and somatostatin.Conclusion: 1.The mode of operation and postoperative HGB are related to the occurrence of lymphatic leakage after lymphadenectomy for gynecological malignant tumors.The risk of postoperative lymphatic leakage in patients undergoing laparotomy is lower than that in patients undergoing laparoscopic surgery,but the choice of specific surgical methods should be decided according to the patient’s condition and will.The risk of postoperative lymphatic leakage in patients with mild anemia is lower than that in patients with moderate and severe anemia.The amount of intraoperative blood loss and postoperative low prealbumin were the risk factors of lymphatic leakage after lymphadenectomy for gynecological malignant tumors(p < 0.05).The risk of lymphatic leakage in patients with low prealbumin level after operation was higher than that in patients with normal prealbumin level after operation(p < 0.05).The risk of lymphatic leakage in patients with low prealbumin level after operation was higher than that in patients with normal prealbumin level after operation.2.All patients with postoperative lymphatic leakage were improved after conservative treatment such as low-fat and high-protein diet,supplementation of albumin,diuresis and somatostatin.