학술논문
盆腔淋巴结切除术中结扎淋巴管对术后盆腔淋巴囊肿形成的影响——随机对照研究 / Influences of lymphatic vessel ligation in pelvic lymphadenectomy on postoperative lymphocyst formation-a randomized controlled trial
Document Type
Academic Journal
Author
卢淮武; 周晖; 彭永排; 张丙忠; 陆晓楣; 王丽娟; 林仲秋; Huai-Wu Lu; Hui Zhou; Yong-Pai Peng; Bing-Zhong Zhang; Xiao-Mei Lu; Li-Juan Wang; Zhong-Qiu Lin
Source
癌症 / CHINESE JOURNAL OF CANCER. 28(11):1193-1197
Subject
Language
Chinese
ISSN
1000-467X
Abstract
背景与目的:盆腔淋巴囊肿是盆腔淋巴结切除术后的主要并发症之一,细针穿刺抽液、注射硬化剂、中医中药、手术治疗等均加重了患者的痛苦,对这部分患者而言预防更重要.本研究通过比较在盆腔淋巴结切除术中结扎和不结扎盆腔淋巴管断端术后盆腔淋巴囊肿形成的情况,以期寻找能更有效预防盆腔淋巴囊肿的手术方式.方法:选取中山大学附属第二医院妇产科2006年7月至2007年1月接受盆腔淋巴结切除术的妇科恶性肿瘤患者,术前排除心、肺、肝、肾等器质性疾病以及低蛋白血症放疗史,随机分为结扎组(19例)与开放组(20例).结扎组用丝线结扎患者两侧腹股沟深淋巴管、闭孔近端淋巴管、闭孔远端淋巴管、髂总淋巴管、髂内外静脉交叉处淋巴管,开放组则对两侧淋巴管不做结扎处理.于术后第1、4、12、24周分别行盆腔B超检查了解淋巴囊肿形成的情况.结果:两组在病理类型的分布、年龄、身高、体重、体表面积、体重指数、术中出血量、手术时间、术后排气时间、拔管时间和首次住院时间、术后总引流量间的差异均无统计学意义(P＞0.05).开放组术后第1周淋巴囊肿形成率高于结扎组(60.0%:26.3%),差异具有统计学意义(P＜0.05);开放组术后第4周(55.0%:31.6%)、第12周(45.0%:16.7%)、第24周(27.8%:20.0%)淋巴囊肿形成率高于结扎组,差异无统计学意义(P＞0.05).两组术后伤口感染、会阴水肿、下肢水肿、发热、肠梗阻、深静脉血栓形成、尿路梗阻等并发症发生率的差异无统计学意义(P＞0.05).结论:盆腔淋巴结切除术中结扎腹股沟深淋巴管、闭孔近端淋巴管、闭孔远端淋巴管、髂总淋巴管、髂内外静脉交叉处淋巴管在近期能够较有效地防止术后盆腔淋巴囊肿的形成,且不增加术后并发症的发生.
Background and Objective:Pelvic lymphocysts are the most common postoperative complications of pelvic lymphadenectomy. Prevention of this disease is more important than treatment. This randomized study was to evaluate the preventive effect of lymph vessel ligation during pelvic lymphadenectomy on pelvic lymphocyst formation. Methods: A total of 39 patients with gynecologic malignancy,who had pelvic lymphadenectomy in the Second Affiliated Hospital of Sun Yat-sen University from July 2006 to January 2007,were randomized into the ligation group (19 patients) and the non-ligation group(20 patients). All patients had no heart disease,hepatopathy,nephronia, pneumonopathy,hypoproteinemia and no history of radiotherapy. All the patients were followed-up with sonographic evaluation and physical examination for lymphocysts and other postoperative complications at 1, 4, 12, and 24 weeks after operation. Results: No significant differences were observed between the two groups in pathlogic type, age, height, weight, body surface area,body mass index (BMI),operation duration, estimated blood loss, time to the passage of flatus, total drainage volume,duration of drainage, and duration of hospital stay (P＞0.05).The occurrence rate of lymphocysts was significantly lower in the ligation group than in the non-ligation group at one week after operation (26.3% vs. 60.0%, P＜0.05). The rates were slightly lower in the ligation group than in the non-ligation group without significant differences after then (31.6% vs. 55.0% at the 4th week),(16.7% vs. 45.0% at the 12th week),(20.0% vs. 27.8% at the 24th week).No significant differences were observed in the occurrence of other postoperative complications between the two groups(P＜0.05).Conclusion:Ligations of the deep inguinal lymph vessels,obturator lymph vessels,common iliac lymph vessels,and the lymph vessels at the crossing of the external iliac and the inter iliac vein can decrease the occurrence of postoperative lymphocysts in short-term period,and will not increase the occurrence of postoperative complications.
Background and Objective:Pelvic lymphocysts are the most common postoperative complications of pelvic lymphadenectomy. Prevention of this disease is more important than treatment. This randomized study was to evaluate the preventive effect of lymph vessel ligation during pelvic lymphadenectomy on pelvic lymphocyst formation. Methods: A total of 39 patients with gynecologic malignancy,who had pelvic lymphadenectomy in the Second Affiliated Hospital of Sun Yat-sen University from July 2006 to January 2007,were randomized into the ligation group (19 patients) and the non-ligation group(20 patients). All patients had no heart disease,hepatopathy,nephronia, pneumonopathy,hypoproteinemia and no history of radiotherapy. All the patients were followed-up with sonographic evaluation and physical examination for lymphocysts and other postoperative complications at 1, 4, 12, and 24 weeks after operation. Results: No significant differences were observed between the two groups in pathlogic type, age, height, weight, body surface area,body mass index (BMI),operation duration, estimated blood loss, time to the passage of flatus, total drainage volume,duration of drainage, and duration of hospital stay (P＞0.05).The occurrence rate of lymphocysts was significantly lower in the ligation group than in the non-ligation group at one week after operation (26.3% vs. 60.0%, P＜0.05). The rates were slightly lower in the ligation group than in the non-ligation group without significant differences after then (31.6% vs. 55.0% at the 4th week),(16.7% vs. 45.0% at the 12th week),(20.0% vs. 27.8% at the 24th week).No significant differences were observed in the occurrence of other postoperative complications between the two groups(P＜0.05).Conclusion:Ligations of the deep inguinal lymph vessels,obturator lymph vessels,common iliac lymph vessels,and the lymph vessels at the crossing of the external iliac and the inter iliac vein can decrease the occurrence of postoperative lymphocysts in short-term period,and will not increase the occurrence of postoperative complications.