The Clinical Analysis Of Influencing Factors And Treatment Strategies Of Chyle Leak After Lymphadenectomy In Gynecologic Malignancies

Background and ObjectIn recent years,the incidence of gynecological malignancy was increasing year by year,which was a serious threat to our women's physical and mental health.With the enlargement of the operative scope of gynecological malignant tumors,especially in recent years,after the dissection of retroperitoneal lymph nodes,the cases of postoperative chylothorax are not uncommon;the chyle leakage is a clinical manifestation when the chylous fluid overflows into the body cavity(chest,or abdominal cavity)through the lymphatic duct or the thoracic duct.The formation of chyle leakage,which can cause malnutrition,water and electricity hydrolysis disorder,low immune system function,and even life-threatening,so how to minimize the incidence of postoperative chylothorax is crucial.The aim of this study was to investigate the influencing factors and treatment strategies of chyle leak after lymph node dissection in gynecologic malignant tumor.Materials and MethodsRetrospectively analyze the clinical data of 656 patients with gynecological malignant tumor who were admitted to our hospital from January 2010 to June 2016 and underwent lymphadenectomy,then according to the presence of chylous leak all the patients were assigned to two groups: chylous leakage group and no chylous leakage group.We explored and analyzed the relationship between chyle leak and the patients' age,BMI,with or without anemia,with or without hypoproteinemia,with or without diabetes mellitus,with or without lymph node enlargement,operation way,lymph node cleaning scope,the lymph node by abdominal aorta level,operation time,intraoperative blood loss,the number of lymph node cleaning and lymph node metastasis.In addition,for ovarian cancer patients,their condition with or without hyperthermic intraperitoneal chemotherapy was a possible influence to count.Results1.There were 656 cases in all patients and 31 cases in the chylous leakage group,with the incidence rate of 4.73%.The single factor analysis showed that the differences between two groups in preoperative BMI,with or without anemia,with or without hypoproteinemia,with or without lymph node metastasis,lymphadenectasis,lymph node number,lymph node cleaning scope,and intraoperative blood loss,operative time,the lymph node by abdominal aorta level were statistically significant(P<0.05);but there were no marked differences in age,with or without diabetes mellitus and surgical approach between the two groups(P>0.05);further multivariate Logistic regression analysis showed that only the preoperative BMI,Intraoperative blood loss,lymphadenectasis were independent risk factors of chylous leakage after surgery(P<0.05).2.In this study,all the 31 cases of chylous leakage were cured by conservative treatment.Ten of the patients with somatostatin and the time with the drainage tube was 13.0 ± 5.107 days,and the time of those who didn't use the drug was 18.4 ± 6.168 days.And this difference was statistically significant between them(P<0.05).Conclusion1.Clinical attention should be paid to the patients BMI,Intraoperative blood loss,lymphadenectasis and other indicators,to reduce the incidence of postoperative chyle leak,improve the prognosis of patients.2.Once a patient is diagnosed chylous leak,the first choice is consevative treatment.In general,the prognosis is good after positive treatment.The use of somatostatin helps the patient recover.