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。

Comparison of ligation and electric coagulation of lymph vessels during pelvic lymphadenectomy

Objective:To compare the formation of pelvic lymphocyst after ligation and electric coagulation of lymph vessels during pelvic lymphadenectomy,find a more effective method to prevent pelvic lymphocyst.Methods:The patients with cervical cancer who underwent pelvic lymphadenectomy in the hospital from June 2008 to December 2010 were selected.Forty-two patients in study group were treated with ligation of bilateral inguinal deep lymphatic vessels,proximal obturator foramen lymphatic vessels,distal obturator foramen lymphatic vessels,common iliac lymphatic vessels,lymphatic vessels at the junction of internal iliac vein and external iliac vein with silk thread during operation;thirty-six patients in control group were treated with electric coagulation to close corresponding lymphatic vessels.Physical examination and type B ultrasonography were performed among the patients in the two groups on the first week,the fourth week,the twelfth week,and the 24th week after operation to explore the formation of pelvic lymphocyst or not and the occurrence of other related complications or not.Results:There was no significant difference in basic conditions,postoperative hospital stay,operative time,the amount of blood loss during operation,postoperative exhausting time,the number of cases with displacement ovary,lymph node metastasis,and the amount of postoperative drainage between ligation group and electric coagulation group.The incidences of lymphocyst in electric coagulation group on the first weeks,the fourth week,and the twelfth weeks after operation were higher than those in ligation group;there was no significant difference in the incidence of lymphocyst on the 24th weeks after operation between the two groups.Conclusion:Compared with electric coagulation of lymph vessels during pelvic lymphadenectomy,ligation of inguinal deep lymphatic vessels,proximal obturator foramen lymphatic vessels,distal obturator foramen lymphatic vessels,common iliac lymphatic vessels,lymphatic vessels at the junction of internal iliac vein and external iliac vein with silk thread can reduce the incidence of pelvic lymphocyst more effectively.