早期子宫颈癌患者术后盆腔淋巴囊肿的发生情况及原因分析

目的：探究早期子宫颈癌患者接受手术治疗后盆腔淋巴囊肿的发生及其与临床病理因素的相关性。方法：回顾性分析2013年1月至2015年12月,以及2019年1月至2019年12月于云南省肿瘤医院妇科接受初始根治性手术的663例早期子宫颈癌患者的临床资料,并根据术后是否发生盆腔淋巴囊肿分为淋巴囊肿组和无淋巴囊肿组。采用单因素和多因素Logistic回归分析术后盆腔淋巴囊肿形成的危险因素。结果：663例接受手术治疗的早期子宫颈癌患者术后盆腔淋巴囊肿的发生率为62.59%(415/663)。单因素分析显示盆腔淋巴囊肿的发生与使用的引流管类型和术后是否接受辅助化疗有关（P <0.05）。多因素分析结果显示使用负压引流管是术后盆腔淋巴囊肿发生的保护因素（P <0.05）。单因素分析显示盆腔淋巴囊肿的发生时间与FIGO分期、肿瘤分化程度、子宫颈肌壁浸润深度、切除淋巴结总数、切除髂总淋巴结总数、是否存在淋巴结转移、使用引流管类型和术后是否接受放化疗有关（P <0.05）。多因素分析显示使用负压引流管、术后未接受辅助放化疗是淋巴囊肿早期形成的保护因素（P <0.05）。结论：相较传统T型引流管,使用负压引流管可能可以降低早期子宫颈癌患者术后盆腔淋巴囊肿的发生率;术后接受辅助放化疗的患者发生盆腔淋巴囊肿的时间可能更早。     

盆腔淋巴结清扫术后盆腔淋巴囊肿预防探讨

目的：探讨超声刀和百克钳在妇科恶性肿瘤腹式根治术中的应用。方法：回顾分析2009年1月—2010年10月郑州大学第一附属医院58例应用超声刀或百克钳的腹式盆腔淋巴结清扫术患者及100例未应用超声刀或百克钳的腹式盆腔淋巴结清扫术患者临床资料,比较手术时间、术中出血量、清扫淋巴结个数、引流液量、尿管留置时间、淋巴囊肿发生例数,住院时间及术后盆腔淋巴囊肿的发生率。结果：治疗组手术时间、术中出血量、引流液量低于对照组,术后淋巴囊肿发生率明显低于对照组,差异有统计学意义（P＜0.05）。结论：腹式盆腔淋巴结清扫术中使用超声刀或百科钳能有效地缩短手术时间、减少术中出血量、降低术后淋巴囊肿的发生率,在妇科肿瘤根治术中值得推广。     

子宫内膜癌术后盆腔淋巴囊肿危险因素分析

目的探讨子宫内膜癌术后盆腔淋巴囊肿形成的危险因素。方法收集2009年1月至2016年4月天津医科大学总医院妇产科行盆腔和(或)腹主动脉旁淋巴结切除的子宫内膜癌患者397例,术后发生淋巴囊肿者76例。结果子宫内膜癌盆腔和(或)腹主动脉旁淋巴结切除后淋巴囊肿的发生率为19.14%,单因素分析发现淋巴结切除范围、FIGO分期、术后化疗、术后放疗及术后放疗联合化疗与淋巴囊肿发生相关(P=0.002,P=0.010,P=0.046,P=0.040,P=0.030)。多因素Logistic回归分析,发现盆腔+腹主动脉旁淋巴结切除是淋巴囊肿形成的独立危险因素(P=0.014)。结论淋巴囊肿是子宫内膜癌盆腔和(或)腹主动脉旁淋巴结切除后的常见并发症,采取个体化治疗,避免不必要的大范围的淋巴结清扫,将会减少淋巴囊肿的发生。     

阴道断端半开放缝合对淋巴结清扫术后盆腔淋巴囊肿预防作用研究

目的探讨阴道断端半开放缝合对淋巴结清扫术后盆腔淋巴囊肿的预防作用。方法收集2012年1月至2018年9月中国医科大学附属盛京医院术中同时行盆腔和(或)腹主动脉旁淋巴结切除的子宫内膜癌及宫颈癌患者348例。根据阴道断端处理方式不同,将348例患者分为半开放组102例与闭合组246例。回顾性比较两组患者手术时间、清扫淋巴结个数、术后引流时间、术后白蛋白含量及血红蛋白含量上的差异,淋巴囊肿发生率及症状型淋巴囊肿发生率。结果半开放组与闭合组在手术时间、清扫淋巴结个数、术后引流时间、术后白蛋白含量及血红蛋白含量上差异均无明显统计学意义(P均0.05),半开放组术后淋巴囊肿发生率及症状型淋巴囊肿发生率分别为35.3%、3.9%,均明显低于闭合组(79.3%、19.5%);形成淋巴囊肿平均直径4.1cm也明显低于闭合组5.9cm,差异均具有统计学意义(P均0.05)。结论淋巴结清扫术后半开放缝合阴道断端是预防术后盆腔淋巴囊肿形成的有效途径,方法简单、效果可靠,无手术难度,不增加术后并发症,值得临床推广。     

子宫颈癌根治术后盆腔淋巴囊肿25例分析

目的 探讨宫颈癌患者根治术后盆腔淋巴囊肿的临床特点和治疗.方法 河南科技大学第一附属医院1998-10-2005-10收治宫颈癌根治术后出现盆腔淋巴囊肿患者25例,对其临床资料进行回顾性分析.结果 术后不同时间内盆腔淋巴囊肿的发生率差异有统计学意义（χ^2＝21.04,P﹤0.01）以术后1～2周发生率最高,囊肿较小者中药口服加局部理疗,较大者穿刺引流,囊肿﹥5cm的患者10例中8例出现下肢肿胀、疼痛等压迫症状,给予抗凝治疗后预后良好.结论 多数盆腔淋巴囊肿可采用保守治疗,必要时可引流治疗.淋巴囊肿压迫髂血管引起下肢症状时应作相关检查,须及时给予抗凝治疗,以防下肢静脉血栓形成.     

盆腔/主动脉旁淋巴结切除后的淋巴囊肿和并发症取决于腹膜的关闭

妇科恶性肿瘤的手术治疗除切除原发肿瘤外,还包括区域性淋巴结的切除,术后可能在后腹膜创伤区域形成淋巴囊肿。文献报道这种淋巴聚积的发生在1.5％～48.5％之间。作者在关闭盆腔腹膜形成淋巴囊肿的前瞻性研究中,术后48％引起淋巴囊肿。     

妇科恶性肿瘤腹膜后淋巴结切除术路径、要点及并发症防治

腹膜后(包括盆腔和腹主动脉旁)淋巴结切除在妇科恶性肿瘤的治疗中有重要的作用,常见的手术路径包括经腹腔路径和腹膜外路径。手术路径的选择取决于疾病治疗的整体方式、患者的特点和手术医师的技术特点。手术需要由有经验的妇科肿瘤医师实施。术中及术后近期并发症包括血管损伤、输尿管损伤、肠管损伤、神经损伤、围手术期感染,远期并发症最常见的是术后淋巴囊肿和下肢淋巴水肿。在淋巴囊肿和下肢淋巴水肿的预防中,应注意术后开放后腹膜,尽量避免使用引流管及合理使用能量器械等。     

滑石粉治疗盆腔淋巴结清扫术后淋巴囊肿

淋巴囊肿是妇科恶性肿瘤盆腔淋巴清扫术后常见的并发症，小囊肿常无症状，可自然吸收，较大囊肿可引起严重的并发症，治疗也较棘手。我们应用无菌滑石粉治疗盆腔淋巴囊肿20例，现将体会报道如下。     

妇科盆腔淋巴结清扫术后淋巴囊肿的防治

盆腔淋巴囊肿是盆腔淋巴结清扫术后常见的并发症,发生率报道不一,为4.3%～48%[1-2].它可以引起下肢静脉回流障碍,增加下肢深静脉血栓的形成机会,增加肺栓塞的发生率,也可以继发感染[3-4].严重者可以影响患者术后的生活质量.因此,有效的预防淋巴囊肿形成,及时治疗淋巴囊肿具有重要的临床意义.     

妇科恶性肿瘤术后淋巴囊肿发生及合并感染的相关因素及疗效分析

目的:探讨妇科恶性肿瘤术后淋巴囊肿发生及合并感染的相关因素及疗效分析。方法:回顾性纳入兰州大学第一医院妇产科自2017年1月2019年1月因妇科恶性肿瘤行腹腔镜手术治疗后的351例患者,根据有无淋巴囊肿的发生分为淋巴囊肿组和无淋巴囊肿组,对2组患者的一般情况、术中情况、术后实验室检查及临床病理情况进行比较。结果:单因素分析显示,妇科恶性肿瘤术后淋巴囊肿组与无淋巴囊肿组的切除淋巴结数目(P=0.000)、引流管留置时间(P=0.013)、术后放疗(P=0.005)、患者体质量指数(BMI,P=0.000)以及三酰甘油水平(P=0.004)比较,差异有统计学意义;Logistic回归分析显示术中切除淋巴结数目和患者的BMI是淋巴囊肿形成的独立影响因素(P<0.05)。淋巴囊肿合并感染者20例,发生率为17.85%;单因素分析显示感染与囊肿直径(P=0.000)、糖尿病(P=0.000)密切相关;Logistic回归分析显示囊肿直径是淋巴囊肿合并感染的独立影响因素(OR=4.375,P=0.041)。结论:妇科恶性肿瘤盆腔淋巴结切除术后发生淋巴囊肿的相关因素有切除淋巴结数目、引流管留置时间、术后辅助放疗、患者BMI及三酰甘油,囊肿直径是淋巴囊肿合并感染的独立危险因素,穿刺引流联合抗生素可作为其推荐治疗方式。     

Pelvic lymphocele following radical para-aortic and pelvic lymphadenectomy for cervical carcinoma: incidence rate and percutaneous management

Thirty-six women, treated with radical hysterectomy (Piver types III-IV) plus systematic para-aortic and pelvic lymphadenectomy for cervical carcinoma, underwent serial postoperative ultrasound examinations to determine the incidence of lymphocele and the therapeutic efficacy of percutaneous catheter drainage. Pelvic lymphoceles, ranging in volume from 46-300 mL, occurred in eight patients (22.2%) between the 12-24th postoperative day. Percutaneous catheter drainage, inserted under local anesthesia, was used for a mean time of 14.5 days (range 4-32), resulting in a mean daily drainage of 92.2 mL and a mean total volume of 1727.5 mL per patient. Catheter drainage allowed complete clinical and sonographic remission in all cases, and only one asymptomatic recurrence was observed at 3-month and 6-month follow-up. Ultrasound-guided percutaneous catheter drainage has proved to be a well-tolerated, safe, and effective technique in the management of lymphocele that obviates the need for more invasive surgical procedures.     

Effective treatment of pelvic lymphocele by lymphaticovenular anastomosis

ObjectivePelvic lymphocele can be a severe complication associated with surgical procedures such as pelvic lymphadenectomy. Lymphaticovenular anastomosis (LVA) is increasing in popularity as a surgical treatment for lymphedema. The aim of this study was to evaluate whether LVA is an effective treatment for lymphocele, which is caused by an obstruction of the lymphatic flow in a manner similar to the development of lymphedema.MethodsEleven female patients, who presented with lymphocele, were treated with LVA. Before the operation, 3 of them were treated with a percutaneous catheter. Lymphocele size and the volume of daily drainage were measured before and after LVA.ResultsThe lymphocele was completely resolved in 6 patients and partially resolved in the remaining 5 patients. The mean size of the pelvic lymphocele changed from 400 ml (range 50–1050 ml) to 43 ml (range 0–120 ml) (P < 0.01). In the 3 patients who had percutaneous drainage catheters, the volume of fluid drained decreased from 340 ml/day to 20 ml/day after LVA.ConclusionsOur technique is minimally invasive and is performed under local anesthesia. LVA is effective regardless of the size of the lymphocele. Therefore, LVA should be considered as a therapy for lymphocele because of its low invasiveness and its effectiveness in re-establishing circulation of lymphatic flow. Further studies should be performed to compare LVA with other minimally invasive techniques, such as percutaneous catheter and sclerotherapy.     

Seroma after axillary lymph node dissection in breast cancer

Since the advent of sentinel node biopsy, which made it possible to reduce the morbidity of axillary surgery, axillary lymph node dissection has been constituting the treatment of reference in certain cases of breast cancer. One of the most frequent complications in the immediate postoperative period is the lymphocele or seroma, the frequency of which is independent of the axillary technique of surgery. Following an analysis of the literature, some risk factors were isolated such as a high body mass index, the high volume of the first three days drainage and arterial hypertension. Some techniques seem to show a benefit in the reduction of the lymphocele: sentinel node biopsy, padding of the axilla and the axillary drainage. The majority of other techniques such as the use of fibrin sealant, hemolymphostatic sponges, various techniques of axillary dissection, external axillary compression, differed mobilization from the upper limb, axillary dissection by lipo-aspiration and endoscopic axillary dissection, have too contradictory results at the present time to be recommended in clinical practice. No consensus is clearly established to decrease the incidence and the volume of the seroma after axillary dissection in breast cancer. Today, two techniques can be nevertheless distinguished: sentinel node biopsy and padding of the axilla.     

Management of persistent lymphocele by sclerotherapy with doxycycline

Three cases of lymphocele after lymphadenectomy for gynecologic malignancy are presented. These patients had large, symptomatic lymphoceles resistant to percutaneous catheter drainage. Sclerotherapy with a single dose of doxycycline was administered percutaneously to each patient. Single treatment achieved resolution in two patients. The third had a persistant lymphocele requiring excision. To our knowledge, doxycycline has not been used for sclerotherapy for lymphocele following radical gynecologic surgery. It may represent a viable addition to the conservative management of lymphoceles.     

Simple one-step catheter placement for the treatment of infected lymphocele

OBJECTIVE: A pelvic lymphocele is a cystic collection of lymph fluid in the pelvis following pelvic lymphadenectomy. This retrospective study was undertaken to show the efficacy and safety of simple one-step catheter placement for the treatment of infected lymphocele. STUDY DESIGN: Ten infected lymphoceles were treated in nine patients. The percutaneous drainage procedures were performed using simple one-step trocar technique under sonographical guidance. The one-step pig tail catheter system consists of an 18-gauge needle, stylet, and 7F drainage tube. A 33% povidone-iodine solution was instilled and left in the cavity for 30 min twice daily. RESULTS: Overall, 9 of the 10 infected lymphoceles were successfully treated with one-step catheter drainage. Percutaneous catheter drainage was maintained for 2-17 days. One of the patients required open surgery for the persistence of infected lymphocele due to the catheter dislodgment. No patients encountered sepsis, bowel perforation, and neurovascular injury. CONCLUSION: Simple one-step procedure enables long-term drainage and is a well-tolerated, safe, and effective technique in the management of infected lymphocele.     

Laparoscopic marsupialization of pelvic lymphocele under transvaginal ultrasonographic guidance

Lymphocyst formation is a common complication of pelvic lymphadenectomy. We treated a 54-year-old woman with lymphocele by laparoscopic marsupialization. She developed hydronephrosis as a result of retroperitoneal lymphocele after total abdominal hysterectomy and pelvic lymphadenectomy for endometrial cancer. Laparoscopic marsupialization under transvaginal ultrasonographic guidance was chosen because conservative therapy including percutaneous or transvaginal drainage ran the risk of bowel perforation. The 6-cm collection was opened and its edges were coagulated electrosurgically and sutured with the surrounding peritoneum. The postoperative course was satisfactory, and hydronephrosis was resolved. This highly effective minimally invasive procedure was beneficial to the patient.     

腹腔镜治疗异位妊娠85例临床分析

目的:探讨电视腹腔镜治疗异位妊娠的安全性、优越性。方法:回顾2008.1-2010.6我院收治的异位妊娠患者,其中85例采用腹腔镜治疗,与同期45例开腹手术相比较,根据妊娠部位及患者有无生育要求及盆腔具体情况,采用不同手术方式。结果:85例腹腔镜手术均获成功,无一例中转开腹。两组病人在年龄、腹部手术史、慢性盆腔炎史,无明显差异;比较两组手术时间、术中出血量、术后排气时间、术后镇痛时间及住院时间,两组有显著差异。结论:腹腔镜治疗异位妊娠是一种理想手术方式,是安全的,且不需要进腹,腹部无疤痕,术后粘连少,对需要以后多次手术的尤为适用。     

Synthetic cyanoacrylic glue in the prevention of post-operative lymphocele after pelvic lymphadenectomy in patients with uterine malignancies: A prospective,single-blind,preliminary study

Objectives

Lymphoceles are among the most common post-operative complications of pelvic lymphadenectomy, with a reported incidence of 1% to 29% in gynecology oncology. Several studies evaluated the effectiveness of biological glues on reducing lymphoceles, but no data on gynecological patients are available. We evaluated the effectiveness of cyanoacrylic glues (n-butyl cyanoacrylate) (Glubran 2 — GEM s.r.l., Italy) in preventing lymphocele on 30 patients who underwent pelvic lymphadenectomy for endometrial or cervical cancer.

Methods

Single-blind prospective randomized study. Patients were divided into 2 groups: pelvic lymphadenectomy plus n-butyl cyanoacrylate (treatment group: 44 patients) and pelvic lymphadenectomy without n-butyl cyanoacrylate (control group: 44 patients). Primary endpoint was incidence of pelvic lymphocele in the two groups 30 days after surgery, and evaluated with pelvic ultrasound and RMI examination. Secondary endpoints evaluated drainage volume of lymphorrhea 36, 48, 72 and 96 h after surgery.

Results

15% in the treatment group and 36.6% in the control group had lymphocele 1 month after the procedure (p < 0.03; RR 0.4 [95% CI 0.152–0.999]). Concerning the secondary outcome in group A the amount of lymphorrhea presented a constant significant decrease during evaluation; on the contrary, in group B, after an initial decrease at 48 h, the amount of lymphorrhea remained unchanged; at all considered times the amount of lymphorrhea resulted significantly greater in controls.

Conclusion

Intraoperative application of n-butyl cyanoacrylate seems to reduce lymph production after pelvic lymphadenectomy, providing a useful additional treatment option for reducing drainage volume and preventing lymphocele development after pelvic lymphadenectomy.     

A novel therapeutic strategy for chylous ascites after gynecological cancer surgery: a continuous low-pressure drainage system

Purpose

Postoperative chylous ascites is an unusual complication following retroperitoneal surgery. A search of the English literature showed only 44 cases of chylous ascites following gynecological cancer surgery. The treatment is primarily conservative, but surgical treatment is considered in resistant cases. We developed a novel non-surgical therapeutic strategy for postoperative chylous ascites.

Methods

We report a case of severe chylous ascites following pelvic lymph node dissection for gynecological cancer.

Results

Total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washing, and systematic pelvic lymph node dissection were performed for a stage II G1 endometrioid adenocarcinoma (FIGO 2009). Forty-one days after surgery, the patient was readmitted due to massive ascites. Repeated paracentesis and a low-fat diet were only partially effective. Fifty-one days after surgery, we started paracentesis with a continuous low-pressure drainage system. Nine days later, there was no further fluid drainage. The patient was asymptomatic and without recurrent disease at follow-up 3 months later.

Conclusions

Pelvic lymph node dissection may cause postoperative chylous ascites. Paracentesis with a continuous low-pressure drainage system can be an effective conservative treatment for postoperative chylous ascites.