置管引流在妇科肿瘤术后盆腔深部淋巴囊肿中的应用

目的 探讨超声引导下经盆壁髂血管深部入路置管引流在妇科恶性肿瘤术后盆腔深部淋巴囊肿中应用的可行性、安全性和有效性。 方法 选取浙江省肿瘤医院2017年1月—2018年12月收治住院的75例妇科恶性肿瘤手术患者，术中均行盆腔淋巴结清扫术，术后出现82个盆腔深部淋巴囊肿，其中无伴随症状的淋巴囊肿6个，有伴随症状的淋巴囊肿76个，伴有疼痛45例、发热32例、下肢水肿12例、下肢血栓1例、同侧肾脏积水3例。选择超声引导下经盆壁髂血管深部入路穿刺置管，观察该路径的可行性、置管成功率、并发症情况以及疗效。 结果 82个淋巴囊肿中，78个存在置管路径，该路径可行性为95.1%。置管过程中1例因盆壁血管穿刺出血终止置管，1例因髂外动脉穿刺出血终止置管，并发症发生率为2.7%。除2例出血患者外，所有病例均完成置管，其中3例置管完成后同侧下肢麻木无力无法行走予以拔管，且均发生在通过该路径置管的初始阶段，置管成功率为93.9%。术后随访显示无症状淋巴囊肿均缩小原径线1/2以上，有症状的淋巴囊肿症状消失49例，症状缓解15例，置管引流总有效率为85.4%。 结论 对于妇科肿瘤术后盆腔深部淋巴囊肿，直接经腹壁穿刺置管无安全路径时，经盆壁髂血管深部入路可以使绝大多数患者实现置管引流，且安全性好、有效率高，值得在临床推广。 

Application of catheter drainage in deep pelvic lymphocyst after gynecological malignancies operation

Objective To evaluate the feasibility, safety and efficacy of ultrasound-guided catheter drainage via pelvic wall and deep vessels in deep pelvic lymphocyst after gynecological malignancies surgery. Methods A total of 82 deep pelvic lymphocysts in 75 patients from January 2017 to December 2018 after gynecological malignancies surgery, there is no safe catheter drainage approach via abdominal wall. Among them, there were 6 cases of lymphocyst without accompanied symptoms; 76 cases of lymphocyst with accompanied symptoms, including 45 cases of pain, 32 cases of fever, 12 cases of lower limb edema, 1 case of lower limb thrombus and 3 cases of hydronephrosis. The feasibility, success rate, complication and efficacy of the approach via pelvic wall and deep vessels were observed. Results Among 82 lymphocysts, 78 Lymphocysts had catheter drainage approach, the feasibility of this approach was 95.1%. During the operation, one case failed due to pelvic wall vessel hemorrhage and one case failed due to arteriae iliaca externa hemorrhage, the incidence of complications was 2.4%. Regarding the success rate of catheterization, all cases completed the operation except 2 bleeding cases. After catheterization, 3 patients' drainage tube were removed because of lower limb numbness, and all of them occurred in the initial stage of catheterization through this route. The success rate of catheter drainage was 93.9%. Postoperative follow-up showed that the diameter of all the asymptomatic lymphatic cysts was reduced by more than 1/2, among the symptomatic lymphatic cysts, 49 cases had disappeared symptoms, 15 cases had relieved symptoms, the effective rate of catheter drainage was 85.4%. Conclusion If there is no safe approach to catheter drainage for deep pelvic lymphocysts through abdominal wall, approach via pelvic wall and deep vessels can make most patients achieve catheter drainage, which is safe and effective, and is worthy of clinical promotion.