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相关研究

发布时间：2018-04-25 04:08

本文选题：淋巴结清扫术 + 淋巴囊肿　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:探讨妇科恶性肿瘤行盆腔淋巴结清扫术后淋巴囊肿形成及感染的相关因素和治疗措施。方法:收集山西省肿瘤医院妇二科自2013年6月~2016年6月因妇科肿瘤行盆腔淋巴结清扫术的患者,对符合入组条件的498例患者进行回顾性分析,根据有无淋巴囊肿形成分为淋巴囊肿组与无淋巴囊肿组。分析患者年龄、肿瘤类型、有无糖尿病史、淋巴管断端闭合方式、后腹膜关闭与否、引流管引出方式、术后出现贫血、血小板低下、低蛋白血症、肝功能异常以及术后病理情况、留置引流管时间、术后24小时引流量等因素与淋巴囊肿形成和感染的相关性。采用X 2检验、Fisher确切概率法及logistic回归模型进行统计学分析。结果:1.采用X 2检验进行组间比较显示:盆腔淋巴囊肿的形成与淋巴结清扫术中淋巴管断端闭合方式、后腹膜闭合与否、引流管引出方式、术后低蛋白血症、肝功能异常及切除淋巴结数目、留置引流管时间、术后24小时引流量相关(P0.05);而与年龄、肿瘤类型、有无糖尿病史、术后贫血、术后血小板低下及转移淋巴结数目无明显相关(P0.05)。2.采用Logistic回归进行相关性分析结果显示:(1)淋巴管断端闭合方式、后腹膜处理方式及切除淋巴结数目是淋巴囊肿形成的独立危险因素(P0.05),而术后低蛋白血症、肝功能异常、留置引流管时间并不是淋巴囊肿形成的独立危险因素(P0.05);(2)采用超声刀闭合淋巴管断端与锐、钝性撕脱法相比,淋巴囊肿形成风险增加1.423倍(OR值为1.423);(3)后腹膜开放属淋巴囊肿形成的保护性因素(B值为-0.747);(4)淋巴结切除数目越多,淋巴囊肿形成的风险越大,切除淋巴结数目每增加10个,淋巴囊肿形成的风险增加1.396倍(OR值为1.396)。3.淋巴囊肿感染最主要的致病菌为大肠埃希菌,占57.69%。采用X 2检验分析淋巴囊肿感染与淋巴囊肿直径、单双侧发生、引流管引出方式、留置引流管时间密切相关(P0.05)。采用Fisher确切概率法比较单纯抗生素(有效率为28.57%)与联合超声引导下淋巴囊肿穿刺引流术(有效率为71.43%)治疗淋巴囊肿感染的疗效,差异具有统计学意义(X 2=12.857,P0.05)。结论:1.采用超声刀闭合淋巴管断端可增加术后淋巴囊肿发生率;2.后腹膜开放可降低淋巴囊肿发生率;3.切除淋巴结数目越多,淋巴囊肿形成的风险越大;4.淋巴囊肿感染主要致病菌为大肠埃希菌,且与囊肿体积较大(5cm以上)、双侧发生、引流管经阴道引出、留置引流管时间长密切相关;抗生素治疗联合超声引导下穿刺引流术是治疗淋巴囊肿感染的有效措施。
[Abstract]:Objective: to investigate the related factors and treatment of lymphocyst formation and infection after pelvic lymph node dissection for gynecologic malignant tumors. Methods: from June 2013 to June 2016, 498 patients with gynecological neoplasms underwent pelvic lymph node dissection. According to the formation of lymphocysts, they were divided into two groups: lymphocysts and non-lymphocysts. Age, tumor type, history of diabetes, closure of lymphatic broken ends, closure of posterior peritoneum, drainage, postoperative anemia, thrombocytopenia, hypoproteinemia, The relationship between lymphocyst formation and infection was found in abnormal liver function, postoperative pathological condition, the time of indwelling drainage tube and 24 hours of postoperative drainage. Using X 2 test, Fisher exact probability method and logistic regression model were used for statistical analysis. The result is 1: 1. The results of X 2 test showed that the formation of pelvic lymphocysts and the closure of lymphatic vessels during lymph node dissection, the closure of posterior peritoneum, the way of drainage, the hypoproteinemia after operation, and so on. The abnormal liver function, the number of lymph nodes removed, the time of indwelling drainage tube, 24 hours after operation were correlated with the drainage flow (P 0.05), but there was no significant correlation with age, tumor type, history of diabetes, postoperative anemia, postoperative thrombocytopenia and the number of metastatic lymph nodes. The results of correlation analysis by Logistic regression showed that the closed end of lymphatic vessels, the treatment of posterior peritoneum and the number of lymph nodes were the independent risk factors of lymphocyst formation, but the postoperative hypoproteinemia and liver function were abnormal. The time of indwelling drainage was not an independent risk factor for lymphocyst formation (P 0.05). The ultrasonic knife was used to close the broken end of lymphatic vessel compared with acute and blunt avulsion. The risk of lymphocyst formation was increased by 1.423 times (OR = 1.423).) the more the number of lymphadenectomy, the greater the risk of lymphocyst formation, the more the number of lymph nodes were increased, the more the number of lymph nodes was increased, the more the number of lymph nodes was increased, and the more the number of lymphadenectomies was -0.747%, the more the risk of lymphocyst formation was. The risk of lymphoid cyst formation increased by 1.396 times with OR value of 1.396U. 3. The most common pathogen of lymphocyst infection was Escherichia coli, accounting for 57.69%. X _ 2 test was used to analyze the relationship between lymphocyst infection and lymphocyst diameter, unilateral and bilateral occurrence, drainage way and time of indwelling drainage tube. Fisher exact probability method was used to compare the efficacy of antibiotic alone (effective rate 28.57) and combined ultrasound guided lymphocyst puncture and drainage (effective rate 71.43) in the treatment of lymphocyst infection. The difference was statistically significant (P 0.05). Conclusion 1. Closing the broken end of lymphatic vessel with ultrasonic knife can increase the incidence of lymphocyst after operation. Posterior peritoneal opening can reduce the incidence of lymphoid cysts by 3%. The greater the number of lymph nodes removed, the greater the risk of lymphocyst formation. The main pathogenic bacteria of lymphocyst infection were Escherichia coli, which was closely related to the large volume of cyst (> 5 cm) and bilateral occurrence. The drainage tube was led out through vagina, and the time of indwelling drainage tube was long. Antibiotic therapy combined with ultrasound-guided puncture and drainage is an effective method for the treatment of lymphocyst infection.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.3

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