Department of Urology, Urology Research Institute, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
Fujian Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, China.
World J Urol. 2023 Apr;41(4):1033-1039. doi: 10.1007/s00345-023-04321-2. Epub 2023 Feb 16.
To investigate the risk factors for postoperative lymphorrhea or/and lymphocele (PLL) in patients undergoing radical prostatectomy (RP).
The clinical data of 606 patients were retrospectively collected. The receiver operating characteristic (ROC) curve was utilized to identify the optimal cutoff value. Multivariable logistic regression analysis was used to screen the independent predictors of PLL.
Univariate analysis showed that nine factors differed between the PLL and non-PLL group. Multivariable logistic regression analysis showed that low preoperative fibrinogen level, extraperitoneal surgery, robot-assisted laparoscopic radical prostatectomy (RALRP), and hypoalbuminemia were risk factors and the use of fibrin glue was a protective factor. Correlation analysis showed that the scope of LN dissection (LND) and number of lymph nodes (LNs) dissected were positively correlated with PLL in the extraperitoneal approach, but were not significantly correlated with PLL in the transperitoneal approach. The use of fibrin glue was negatively associated with PLL in the overall procedure and the extraperitoneal approach, but not significantly so in the transperitoneal approach. Comparison of LNs clearance between the two surgical approaches revealed that the extent of LND and number of LNs dissected in the extraperitoneal approach were less than in the transperitoneal approach.
During RALRP, more attention should be paid to fully clotting the broken end of lymphatic vessels. The use of fibrin glue could reduce the probability of PLL. The extent of LND or number of LNs dissected were positively correlated with PLL in the extraperitoneal approach.
探讨根治性前列腺切除术（RP）后淋巴瘘或/和淋巴囊肿（PLL）的危险因素。
回顾性收集了 606 例患者的临床资料。利用受试者工作特征（ROC）曲线确定最佳截断值。采用多变量逻辑回归分析筛选 PLL 的独立预测因素。
单因素分析显示 PLL 组和非 PLL 组有 9 个因素存在差异。多变量逻辑回归分析显示，术前低纤维蛋白原水平、腹膜外手术、机器人辅助腹腔镜根治性前列腺切除术（RALRP）和低白蛋白血症是危险因素，使用纤维蛋白胶是保护因素。相关性分析显示，在腹膜外途径中，LN 清扫范围（LND）和清扫的淋巴结（LNs）数量与 PLL 呈正相关，但在经腹腔途径中与 PLL 无显著相关性。纤维蛋白胶的使用与整体手术和腹膜外途径的 PLL 呈负相关，但在经腹腔途径中无显著相关性。两种手术途径的 LNs 清除率比较显示，腹膜外途径的 LND 范围和 LNs 清扫数量均少于经腹腔途径。
在 RALRP 中，应更加注意充分凝固淋巴管的断端。使用纤维蛋白胶可降低 PLL 的概率。在腹膜外途径中，LND 范围或 LNs 清扫数量与 PLL 呈正相关。
