Effective Management of Pelvic Lymphocysts by Laparoscopic Marsupialfeation

Background and Objectives:

To evaluate laparoscopic transperitoneal marsupialization of pelvic lymphocysts at the time of laparoscopically directed assessment of response to first-line therapy in a population of patients treated for International Federation of Gynecologists and Obstetricians (FIGO) stage IC-IIC epithelial ovarian cancer.

Methods:

Between March 1995 and March 1998, eight patients with FIGO stage IC-IIC serous epithelial ovarian tumors who developed pelvic lymphocysts after primary surgical staging underwent transperitoneal laparoscopically directed marsupialization of lymphocysts at the time of second-look laparoscopy.

Results:

The mean age of the patient population was 50 years (range 23-65 years). The mean length of time required for marsupialization was 30 minutes (range 25-35 minutes). No patient required inpatient postoperative care. No intraoperative complications were observed. Computerized axial tomography (CT) scan of the abdomen and pelvis obtained 12 weeks following surgery failed to demonstrate re-accumulation of lymphocysts among any patient in the study population. With a median follow-up of 20 months (range 3-39 months), no patients have demonstrated pelvic lymphocyst recurrence.

Conclusions and Discussion:

Laparoscopically directed marsupialization of pelvic lymphocysts is technically feasible, safe and effective. Further study of this technique appears to be warranted.     

盆腔淋巴结切除术中结扎淋巴管与电凝闭合淋巴管的比较

目的:比较盆腔淋巴结切除术中丝线结扎和电凝闭合盆腔淋巴管断端术后盆腔淋巴囊肿形成的情况,从而找到更有效预防盆腔淋巴囊肿的方法。方法:选取南阳市中心医院妇产科2008年6月～2010年12月接受盆腔淋巴结切除术的宫颈癌患者。研究组42例,术中用4号丝线结扎双侧腹股沟深淋巴管、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共5处;对照组36例,术中用电凝闭合相应淋巴管。于手术后第1周、第4周、第12周和第24周对患者进行体格检查和B超检查,了解盆腔有无淋巴囊肿形成以及有无其他相关并发症的发生。结果:丝线结扎组与电凝闭合组患者基本情况、术后住院天数、手术时间、术中出血量、术后排气时间、卵巢移位、淋巴结转移,术后引流量比较,无统计学差异。电凝闭合组术后第1周、术后第4周、第12周淋巴囊肿形成率高于结扎组;术后第24周电凝闭合组与结扎组淋巴囊肿形成率无统计学差异。结论:盆腔淋巴结切除术中丝线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比电凝闭合相应淋巴管在术后近期内可以有效地减少盆腔淋巴囊肿的发生率。     

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

 【目的】 通过分析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,寻找能更有效预防盆腔淋巴囊肿的手术方式&#65377; 【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月接受由同一医生主刀的盆腔淋巴结切除术的妇科恶性肿瘤患者,术前排除心&#65380;肺&#65380;肝&#65380;肾等器质性疾病&#65380;低蛋白血症及放疗史,根据由SAS 8.0系统产生的随机数字表相对应,共收集32例,随机结扎左侧或者右侧腹股沟深淋巴管&#65380;闭孔近端淋巴管&#65380;闭孔远端淋巴管&#65380;髂总淋巴管&#65380;髂内外静脉交叉处淋巴管,于术后第1&#65380;4&#65380;12&#65380;24周分别行盆腔B超检查了解结扎侧与开放侧淋巴囊肿形成的情况&#65377; 【结果】 开放侧术后第1周淋巴囊肿形成率高于结扎侧(40.63%:15.63%),其差别具有统计学意义(P < 0.05);术后第4周&#65380;第12周开放侧淋巴囊肿形成率高于结扎侧(43.75%:21.88%&#65380;26.67%:16.67%),差别无统计学差异(P > 0.05);术后第24周开放侧淋巴囊肿形成率低于结扎侧(10.35%:13.79%),差别无统计学差异(P > 0.05)&#65377;【结论】 盆腔淋巴结切除术中结扎腹股沟深淋巴管&#65380;闭孔近端淋巴管&#65380;闭孔远端淋巴管&#65380;髂总淋巴管&#65380;髂内外静脉交叉处淋巴管在近期能够较有效的防止术后盆腔淋巴囊肿的形成&#65377;     

微波联合中药灌肠治疗宫颈癌术后盆腔淋巴囊肿疗效观察

[目的]观察微波联合中药灌肠治疗宫颈癌术后盆腔淋巴囊肿的疗效.[方法]将73例宫颈癌根治术后并发淋巴囊肿的患者随机分为对照组、研究组两组,对照组36例,采用中药外敷的方法进行治疗,研究组37例,采用微波联合中药灌肠的方法进行治疗,观察两组之间疗效的差异.[结果]研究组37例患者中治愈21例,有效14例,无效2例,总有效率94.6％(35/37),与对照组80.6％(29/36)比较差异显著(P＜0.05).[结论]微波联合中药灌肠治疗宫颈癌根治术后并发盆腔淋巴囊肿较中药外敷疗效好.     

盆腔淋巴结清扫术后淋巴囊肿研究进展

盆腔淋巴囊肿是妇科恶性肿瘤盆腔淋巴结清扫术后常见的并发症之一,临床上治疗方法较多,但效果不甚理想。尽可能在手术中预防淋巴囊肿的发生,其临床意义可能更大。文章对妇科恶性肿瘤盆腔淋巴结清扫术后发生淋巴囊肿的机制及治疗方法作一综述。     

310例宫颈癌根治术后并发盆腔淋巴囊肿的临床分析

目的分析宫颈癌根治术后发生盆腔淋巴囊肿的相关因素及治疗效果。方法回顾分析宁夏医科大学附属医院2005年1月至2010年4月行宫颈癌根治术的310例患者的临床资料,其中Ⅰa2期33例,Ⅰb期118例,Ⅱa期159例。结果术后发生淋巴囊肿的患者共36例,发生率为11．61％,其发生与临床分期及术中清扫淋巴结的个数有关,与患者年龄、有无下腹部手术史、有无内科合并症及病理组织分型无关。淋巴囊肿均经局部外敷大黄、芒硝,口服中成药活血化瘀制剂治疗,22例治疗2周后淋巴囊肿消失;8例延长治疗时间2周后,再次复诊,淋巴囊肿亦消失;5例效果不佳,经B超引导穿刺治疗后淋巴囊肿消失;1例因囊肿较大且存在压迫症状手术治疗。结论临床分期及根治术中清扫淋巴结的个数是发生盆腔淋巴囊肿的主要因素,采用中药局部外敷及口服活血化瘀制剂效果较佳。     

盆腔淋巴结清扫术后并发淋巴囊肿及感染的研究进展

盆腔淋巴囊肿是盆腔淋巴结清扫术后常见并发症.尽管部分淋巴囊肿无明显临床表现,但有些淋巴囊肿可能继发感染或持续增大,导致周围血管、器官出现压迫症状,严重影响患者术后的生活质量及肿瘤的后续治疗.该文就妇科恶性肿瘤盆腔淋巴结清扫术后并发淋巴囊肿及感染的术中预防及有效治疗措施进行综述.     

妇科恶性肿瘤术后化疗后淋巴囊肿并发感染及治疗分析

目的:探讨妇科恶性肿瘤术后化疗后淋巴囊肿感染的易感因素、防治方法及预防措施。方法:对67例妇科恶性肿瘤患者术后化疗后淋巴囊肿发生感染及治疗情况进行回顾性分析。结果:中性粒细胞计数(ANC)降低、贫血、年龄>60岁患者淋巴囊肿感染率增高,抗生素联合粒细胞集落刺激因子(G-CSF)治疗使化疗后淋巴囊肿感染患者发热及ANC恢复天数分别缩短为(7.0±1.6)天和(6.0±1.3)天。结论:妇科恶性肿瘤术后患者化疗后ANC降低、贫血、患者年龄>60岁是淋巴囊肿感染感染主要易感因素,抗生素加用G-CSF合理应用,能减少淋巴囊肿感染发生率及严重程度。     

Persistent Lymphocyst after Surgery on a Patient with Endometrial Carcinoma： A Case Report and Review of the Literature

Lymphocyst is one of the main complications of gynecologic malignancies following systematic lymphadenectomy. The majority are asymptomatic. But when it is large enough, the lymphocyst may oppress the ureters and it should be treated. A 48-year-old Chinese woman who had received a subradical hysterectomy plus systematic pelvic and para-aortic lymphadenectomy in our hospital because of endometrial cancer presented persistent lymphocyst. Her symptom was so obviously that we had to aspirate repeatedly in order to relieve its oppression to jacent organs. But the lymphocyst grow so fast and was so intractable, and we had to perform exploratory laparotomy and put negative pressure drainage. When the patient was discharged, the cyst still existed, but the patient was no symptom.     

A prospective randomized study comparing retroperitoneal drainage with no drainage and no peritonization following radical hysterectomy and pelvic lymphadenectomy for invasive cervical cancer

OBJECTIVE: To evaluate the postoperative morbidity and lymphocyst formation in invasive cervical cancer patients undergoing radical hysterectomy and pelvic lymphadenectomy (RHPL) with no drainage and no peritonization compared with retroperitoneal drainage and peritonization. METHODS: Between July 1999 and May 2000, 100 patients with stage IA-IIA cervical cancer undergoing RHPL in Chiang Mai University Hospital were prospectively randomized to receive either no peritonization and no drainage (Group A = 48 cases) or retroperitoneal drainage and peritonization (Group B = 52 cases). Perioperative data and morbidity were recorded. Transabdominal and transvaginal sonography were performed at 4, 8 and 12 weeks postoperatively to detect lymphocyst formation. RESULTS: Both groups were similar regarding age, size and gross appearance of tumor, tumor histology and stage. There was no difference between groups in respect of operative time, need for blood transfusion, intraoperative complications, hospital stay, number of nodes removed, nodal metastases, and need for adjuvant radiation and chemotherapy. Asymptomatic lymphocysts were sonographically detected at 4, 8 and 12 weeks postoperatively in 3 (6.8%), 2 (4.6%), and 3 (7.7%) of 44, 43, and 39 patients, respectively in Group A, whereas none was found in Group B (P = 0.2). No significant difference was found in term of postoperative morbidity in the two groups. CONCLUSION: Routine retroperitoneal drainage and peritonization after RHPL for invasive cervical cancer can be safely omitted.