摘要
目的:对比盆腔清扫术中关闭后腹膜加负压引流与开放后腹膜的并发症发生率,探索盆腔清扫术中后腹膜的处理方法。方法:选取2003年1月至2007年12月在汕头大学医学院肿瘤医院接受手术治疗的宫颈癌285例为研究对象,按照后腹膜处理方式分为:A组(193例)关闭后腹膜并经阴道行负压引流,B组(92例)开放后腹膜不行负压引流。对比两组的临床资料,比较两组术后各种并发症的发生率,分析影响淋巴囊肿形成的主要因素。率的比较采用x2检验,多因素分析采用Logistic回归模型。结果:全组总的淋巴囊肿发生率35.4%(101/285),有症状淋巴囊肿发生率7.7%(22/285),泌尿系统并发症发生率26.3%(75/285)。总的淋巴囊肿发生率A组45.1%(87/193),高于B组15.2%(14/92),P=0.000;有症状淋巴囊肿发生率A组8.8%(17/193),B组5.4%(5/92),差异无统计学意义(降0.477)。盆腔感染和腹水的发生率B组分别为4.3%(4/92)和9.8%(9/92),高于A组0和1.6%(3/193),P值分别为0.010和0.002。结论:盆腔清扫术后关闭后腹膜虽然增加了淋巴囊肿的发生率,但是并不增加有症状淋巴囊肿的发生率,而且明显降低了盆腔感染和腹水形成的可能性。盆腔清扫术后应常规关闭后腹膜并经阴道行负压引流,强调淋巴管的结扎。
Objective： To compare the complications of systemic pelvic lymphadenectomy between retroperitoneal close with suction drainage and retroperitoneal open without drainage, as well as to explore the surgical management of retroperitoneum during systemic pelvic lymphadenectomy. Methods： From Janurary 2003 to December 2007, 285 patients with cervical carcinoma who underwent surgery were divided into two groups according to different management of the retroperitoneum： retroperitoneum closed with suction drain- age via vagina group （group A, n=193）, and retroperitoneum open without suction drainage group （group B, n= 92）. Clinical data and complications of these two groups were compared. Independent factors affecting the formation of lymphocyst were analyzed. Chi-square test was used in ratio comparison, and Logistic regression model was applied in multi-factor analysis. Results： Of all the cases, total incidence of lymphocyst was 35.4% （101/285）, the incidence of symptomatic lymphocyst was 7.7% （22/285）, and the incidence of urinary compli- cations was 26.3% （75/285）. Total incidence of lymphocyst was significantly higher in group A than in group B （45.1% vs 15.2%, P=0.000）, while the incidence of symptomatic lymphocyst was comparable between A and B groups （8.8% vs 5.4%, P=0.477）. Incidence of pelvic cavity infection and ascites was significantly higher in group B than that in group A （4.3%, 9.8% vs 0, 1.6%）. Independent factors affecting formation of lymphocyst were management of retroperitoneum and lymph node involvement. Conclusion： Though close of the retroperitoneum during systemic pelvic lymphadenectomy increases the incidence of lymphocyst formation, it does not increase the incidence of symptomatic lymphocyst. Furthermore, it significantly reduces the possibility of pelvic cavity infection and ascites. Retropedtoneum should routinely be closed with suction drainage during systemic pelvic lymphadenectomy, and careful ligation of the lymphatic duct should be emphasized.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2009年第15期887-890,共4页
Chinese Journal of Clinical Oncology
