子宫内膜癌术后盆腔淋巴囊肿发生相关因素分析

发布时间：2018-05-11 17:27

本文选题：子宫内膜癌 + 淋巴结切除术　；参考：《天津医科大学》2017年硕士论文

【摘要】：目的1.探讨影响淋巴囊肿形成相关的因素,寻找预防或减少淋巴囊肿形成的方法;2.探讨影响淋巴囊肿存在时间长短的相关因素,寻找缩短淋巴囊肿存在时间的方法;3.探讨影响淋巴囊肿感染发生的相关因素,寻找预防或减少淋巴囊肿感染发生的方法;4.探讨淋巴囊肿感染的常见病原菌以及治疗方法与治疗时间的关系,寻找敏感的抗生素和更合适高效的治疗方法。材料方法收集2009年1月~2016年12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430例,术后发生淋巴囊肿者81例,其中60例患者仅需保守治疗,21例患者行抗生素或/和穿刺引流治疗。数据分析应用SPSS19.0统计软件,淋巴囊肿及淋巴囊肿感染发生单因素检验采用χ2检验,多因素分析采用多因素Logistic回归分析;参数检验采用t检验,非参数检验采用Mann-Whitney U检验或/和Kruskal-Wallis检验;淋巴囊肿存在时间相关因素的单因素分析采用Kaplan-Meier方法,经Log-rank方法和Breslow方法检验,多因素分析采用Cox多因素回归分析。结果1.子宫内膜癌患者行盆腔和/或腹主动脉旁淋巴结切除术后淋巴囊肿的发生率为18.84%(81/430),单因素分析发现淋巴结切除范围大、FIGO分期晚期、盆腔淋巴结切除个数≥25、腹主动脉旁淋巴结切除个数≥4与淋巴囊肿发生相关(P=0.001,P=0.026,P=0.019,P=0.024),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=0.033),发生风险是单纯盆腔淋巴结切除患者的2.187倍。2.淋巴囊肿主要发生在术后2个月内。单因素生存分析发现淋巴囊肿的存在时间与淋巴囊肿的直径、淋巴囊肿的分布(单侧或双侧)相关(P1=0.005,P2=0.006;P1=0.054,P2=0.016);淋巴囊肿发生在双侧时淋巴囊肿存在时间长,淋巴囊肿直径≥3.8 cm时淋巴囊肿存在时间明显延长,将单因素有意义的2个因素进行Cox多因素生存分析发现淋巴囊肿直径是影响淋巴囊肿存在时间长短的独立危险因素。3.淋巴囊肿形成时的直径大小与术中腹主动脉旁淋巴结切除个数,术后第一日血PLT、Hb的值相关,淋巴囊肿直径≥4.6cm组患者术中腹主动脉旁淋巴结切除个数多,术后血PLT值低,Hb值低(P=0.017,P=0.019,P=0.009)。4.子宫内膜癌患者行盆腔和/或腹主动脉旁淋巴结清扫的患者术后感染淋巴囊肿的发生率为4.42%(19/430),经单因素分析发现淋巴囊肿直径≥5cm,术后贫血是淋巴囊肿感染发生的相关因素(P0.001,P=0.011),多因素Logistic回归分析,发现淋巴囊肿直径≥5 cm是淋巴囊肿感染发生的独立危险因素(P=0.001),发生风险是淋巴囊肿直径5cm患者的17.956倍。5.送检细菌培养(包括引流液培养和/或血培养)的15例患者中4例阳性,3例为革兰阳性球菌,分别为缓慢葡萄球菌、粪肠球菌、人葡萄球菌;1例为革兰阴性杆菌阴沟肠杆菌复合型。6.在淋巴囊肿感染的治疗中单纯使用抗生素组较抗生素联合穿刺引流组治疗时间短(P=0.020)。并且单纯使用抗生素组较抗生素联合穿刺引流组淋巴囊肿直径小(P=0.046)。在辅以引流治疗的患者中在使用抗生素的3 d以内给予引流者治疗时间较第4 d及以后给予者治疗时间缩短(P=0.045)。结论1.淋巴囊肿是子宫内膜癌患者行盆腔和/或腹主动脉旁淋巴结切除术后的常见并发症,明确手术指征,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。2.淋巴囊肿主要发生在术后2个月内,大多数不需特殊干预,淋巴囊肿的直径和存在部位会影响淋巴囊肿的预后。术前或术后积极关注并改变患者的内环境状态,将会影响淋巴囊肿发生时的大小,从而使得淋巴囊肿的存在时间缩短,改善患者的预后以及生活质量。3.对于已经形成的淋巴囊肿,积极纠正贫状态血,对体积较大的囊肿进行密切随访,将会减少淋巴囊肿感染的发生。4.一旦发生淋巴囊肿感染,以覆盖革兰阳性菌、革兰阴性菌及厌氧菌的广谱抗生素抗感染治疗。对于需要辅以引流治疗的患者在使用抗生素的前3 d内给予,治疗时间将会缩短。
[Abstract]:Objective 1. to explore the related factors affecting the formation of lymphatic cysts and to find a way to prevent or reduce the formation of lymphatic cysts; 2. explore the related factors affecting the duration of lymphatic cysts and find a way to shorten the existence of lymphatic cysts; 3. explore the related factors affecting the incidence of lymphatic cysts, and seek to prevent or reduce lymphatic cysts. The methods of infection; 4. to investigate the common pathogens of lymphatic cysts and the relationship between treatment and time, and to find sensitive antibiotics and more suitable and efficient treatment. Materials and methods were used to collect the uterus of the pelvic and / or abdominal aorta of the Department of Obstetrics and Gynecology of General Hospital Affiliated to Tianjin Medical University in December ~2016 January 2009. There were 430 patients with endometrial carcinoma and 81 cases of lymphatic cysts after operation, of which 60 patients were treated with only conservative treatment and 21 patients were treated with antibiotics or / and puncture drainage. Data analysis applied SPSS19.0 software. The single factor test of lymphatic cysts and lymphatic cysts was tested by x 2 test, and multiple factor analysis of multiple factor Logistic regression analysis was used. T test, nonparametric test using Mann-Whitney U test or / and Kruskal-Wallis test, single factor analysis of time related factors of lymphatic cyst using Kaplan-Meier, Log-rank and Breslow methods, and multivariate analysis of Cox multifactorin regression analysis. Results 1. patients with endometrial carcinoma were treated with pelvic cavity. The incidence of lymphadenectomy was 18.84% (81/430) after the resection of the para aortic lymph nodes and / or abdominal aorta. The single factor analysis found that the lymph node excision range was large, the FIGO stage was late, the number of pelvic lymph nodes excised more than 25, the number of lymph node excision of the abdominal aorta more than 4 was associated with the lymphatic cysts (P=0.001, P=0.026, P=0.019, P=0.024), and multiple factors Logistic Regression analysis revealed that the pelvic and abdominal aortic dissection is an independent risk factor for lymphatic cyst formation (P=0.033). The risk is that 2.187 times the.2. lymphatic cysts in patients with simple pelvic lymphadenectomy are mainly occurred within 2 months after the operation. The distribution of cysts (unilateral or bilateral) is related (P1=0.005, P2=0.006; P1=0.054, P2=0.016); lymphatic cysts have long time to occur in bilateral lymph cysts and lymph cysts longer than 3.8 cm in diameter, and 2 factors of single factor meaningful survival analysis of multiple factors of Cox find that the diameter of lymphatic cyst is the influence. An independent risk factor for the duration of lymphatic cysts, the diameter of.3. lympho cysts was associated with the number of lymph nodes in the para aorta during the operation, the value of PLT and Hb on the first day after the operation, and the number of lymph nodes removed from the abdominal aorta in the group with the diameter of the lymph cyst more than 4.6cm, and the low PLT value after the operation, and the low Hb value (P=0.017, P=0.019, P). =0.009) the incidence of lymphatic cysts in patients with.4. endometrial carcinoma with pelvic and / or abdominal paraaortic lymph node dissection was 4.42% (19/430). The diameter of lymphocysts was more than 5cm by single factor analysis. The postoperative anemia was a related factor of lymphatic cyst infection (P0.001, P=0.011). Multiple factor Logistic regression analysis was used to detect the lymphatic cyst. The diameter of the cyst more than 5 cm is an independent risk factor for lymphatic cysts (P=0.001). The risk is 4 positive and 3 gram-positive cocci in 15 cases of 5cm patients with lymphatic cyst diameter 17.956 times.5. (including drainage and / or blood culture), and 3 cases of gram-positive coccus, respectively, Staphylococcus faecalis, Enterococcus faecalis, and human grape In 1 cases of gram-negative bacilli and Enterobacter cloacae compound.6. in the treatment of lymphatic cysts, the treatment time was shorter than that of the antibiotic group compared with the antibiotic combined puncture and drainage group (P=0.020). And the diameter of the lympho cysts in the group of antibiotics combined with the antibiotic combined puncture and drainage group was small (P=0.046). The time of treatment within 3 D of antibiotics was shorter than that of fourth D and the treatment time was shortened (P=0.045). Conclusion 1. lymphatic cysts are common complications after pelvic and / or para aortic lymph node resection for endometrial cancer patients, and the surgical indications are clearly defined to avoid unnecessary large lymph node dissection. .2. lymphocysts can reduce lymphocysts mainly in 2 months after the operation, most of which do not require special intervention. The diameter and location of lymphocysts will affect the prognosis of lymphocysts. Preoperative or postoperative attention and changes in the patient's internal environment will affect the size of the Lymphocyst, thus making the Lymphocyst. The duration of the swelling is shortened, the prognosis of the patients and the quality of life (.3.), the lymphocysts that have been formed, the positive correction of the poor state of blood, and the close follow-up of the larger cysts, will reduce the incidence of Lymphocyst infection in the case of Lymphocyst infection, to cover Gram-positive bacteria, Gram-negative bacteria and anaerobes. Broad-spectrum antibiotics for anti infective treatment. For patients needing to be treated with drainage, the treatment time will be shortened within 3 D before the use of antibiotics.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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