Study On Lymphatic Leakage After Laparoscopic Radical Cystectomy

Background:With the improvement of the diagnosis and treatment of bladder tumors in recent years,laparoscopic radical cystectomy has become the first choice for the treatment of muscle invasive bladder cancer and high-risk and recurrent non-muscle invasive tumors.Its rare complications can lead to prolonged hospital stay,decreased nutritional status,and increased risk of postoperative infection.If not treated and interfered,it will form a heavier physiological and psychological burden.At present,lymphatic leakage is rarely reported in laparoscopic radical cystectomy,and there is no relevant medical treatment guideline.The factors affecting the diagnosis of the incidence and related treatment are still unclear.Objective:To investigate the related factors leading to lymphatic leakage after laparoscopic radical cystectomy,and to study the role of various factors in the prevention and treatment of postoperative lymphatic leakage.Methods:The clinical data of 160 patients who underwent LRC at the urology department of Qilu Hospital of Shandong University from Jan.2015 to Jan.2019 were retrospectively analyzed and relevant literature was reviewed.The patients were divided into leakage group and non-leakage group.Patients' age,lymph node dissection range,number of lymph nodes,number of positive lymph nodes,whether the lymphatic tissues were clapped with Hemolock after dissection,preoperative and postoperative hemoglobin(HGB),postoperative albumin(ALB)were collected to analyze factors associated with postoperative lymphatic leakage.Results:Lymphatic leakage was detected in 44(27.5%)patients.One-way t-testand ?2 test showed the number of positive lymph nodes and whether lymphatic tissues were clamped with Hemolock after dissection were associated with occurrence of lymphatic leakage,and the latter could significantly reduce incidence of lymphatic leakage(t=2.477,?2=41.215,P<0.05).Logistic regression analysis showed lymphatic leakage was associated with whether lymphatic tissues were clamped with Hemolock after dissection(OR=1 8.482,95%CI=6.872-49.709,P<0.001).All patients were cured after conservative treatment including fasting and unobstructed drainage.Conclusions:The number of positive lymph nodes and whether lymphatic tissues are clamped with Hemolock after dissection are high risk factors of postoperative lymphatic leakage.Conservative treatment and adequate drainage can achieve satisfactory results.Skillful grasp of operation skills,clamping after lymph node dissection,good knowledge of anatomy and careful operation can prevent occurrence of lymphatic leakage.