腹腔镜下子宫内膜癌分期术后引流放置的对比研究

发布时间：2018-07-02 12:00

本文选题：子宫内膜癌 + 腹腔镜　；参考：《山东大学》2017年硕士论文

【摘要】：背景:子宫内膜癌(Endometrial Carcinoma,EC)是原发于子宫内膜的一组上皮性恶性肿瘤,是女性生殖道常见的三大恶性肿瘤之一,约占女性癌症总数的7%,占女性生殖道恶性肿瘤的20%-30%,近年发病率有上升趋势,已经进入女性前十大恶性肿瘤之列。子宫内膜癌主要发生在绝经后妇女,90%以上发病于50岁以上。高危因素主要有糖尿病、肥胖、高血压及三苯氧胺服用史等,常因绝经后阴道流血为主诉而被早期发现。腹腔镜技术的发展日新月异,Childers等人于1992年将腹腔镜手术应用于子宫内膜癌分期手术,现在,腹腔镜手术已经成为治疗妇科恶性肿瘤的重要方法之一。腹腔镜手术治疗子宫内膜癌,其可行性和安全性已获得公认。与开腹手术相比,切除淋巴结数量多,出血量少,术后恢复快,平均住院天数短,成为子宫内膜癌颇具优势的治疗方式之一。腹腔镜下子宫内膜癌分期手术之后,为避免术后盆腔积液及术后淋巴囊肿的形成,常放置盆腹腔引流管,而近年来研究指出,在不关闭后腹膜而且预防性应用抗生素的情况下,妇科恶性肿瘤术后可不放置引流管,不仅不会增加术后并发症的发生率,而且会减轻患者的焦虑心情,减少医护人员对引流管的护理工作,减少引流口的感染率。目的:对于子宫内膜癌患者行腹腔镜下子宫内膜癌分期手术,术后分别给予放置盆腔引流与不放置盆腔引流两种术式,观察两组的术后并发症的发生率,尤其是有症状的淋巴囊肿的形成,盆腔感染等发生。探讨腹腔镜下子宫内膜癌术后不放置盆腔引流的可行性及优点。方法:自2015年06月至2016年06月将山东大学第二医院病理确诊为子宫内膜癌的患者分为两组,行腹腔镜下子宫内膜癌分期手术,术中开放后腹膜。一组术后常规放置盆腹腔引流管两根,称为放置引流组;另外一组术后不放置盆腔引流,常规关闭trocar孔,称为不放置引流组。记录患者的年龄、肿瘤的分期、病理类型、手术时间,淋巴结转移情况,着重记录患者的术后住院天数、尿管拔除时间、术后胃肠功能恢复时间、术后并发症的发生率,如发热、感染、淋巴囊肿的形成率、有症状的淋巴囊肿的形成率、尿潴留、下肢深静脉血栓的形成、术前术后白蛋白的对比,整理记录的数据,计量资料采用均数±标准差(Mean±SD)表示,利用t检验、卡方检验等进行统计学分析。结果:在本试验中,总共记录了有效病例共72例,其中不放置引流组病例32例,放置引流组病例40例,两组患者的年龄、肿瘤的分期、病理类型、淋巴结转移情况均无显著性差异;放置引流组的手术时间为(203.45±42.67)min,不放置引流组的手术时间为(197.38±22.67)min,不放置引流组的手术时间与放置引流组无显著性差异;放置引流组的术后平均住院周期是(10.48±4.01)天,不放置引流组的术后平均住院周期是(7.78±2.7)天,不放置引流组的术后平均住院周期要明显低于放置引流组(t=3.26,P=0.0017,P0.05);放置引流组的术前与术后白蛋白差值是(9.6±3.24)g/L,不放置引流组的术前与术后白蛋白差值是(3.76± 1.48)g/L,不放置引流组术前与术后白蛋白差值明显低于放置引流组(t=9.43,P=0.0000,P0.05);淋巴囊肿的发生率、有症状的淋巴囊肿的发生率及发热、感染两组对比均没有显著性差异(P0.05)。结论:对于行腹腔镜下子宫内膜癌分期手术的患者,在止血彻底的情况下,可以不放置盆腹腔引流管,不放置引流明显优于放置引流,其优点有以下几点:没有增加术后典型并发症淋巴囊肿的发生率,也没有增加有症状的淋巴囊肿的发生率;没有增加盆腔感染及发热的发生率;不放置引流,明显缓解了患者的负面情绪,减轻了患者术后的心理负担及焦虑情绪;不放置盆腔引流管,减少了对引流管的换药、拔管及护理工作,减轻了医护人员的工作量;术后不放置盆腔引流,缩短了住院时间;术后不放置盆腔引流,避免了引流管对穿刺口的刺激,也减少了因为放置盆腔引流管而引起的继发的盆腔感染及穿刺口感染;没有了引流管对盆腔膀胱及髂血管的刺激,有利于膀胱功能恢复及盆腔内血管的腹膜化;不放置引流管,省去了因引流管及引流袋的成本、护理等费用,术后营养支持相对减少,总体减少了患者的住院总费用;不放置引流管,减少了低白蛋白血症的发生率。
[Abstract]:Background: Endometrial Carcinoma (EC) is a group of epithelial malignant tumors of the endometrium. It is one of the three common malignant tumors in female genital tract. It accounts for about 7% of the total number of cancer in women. It accounts for the 20%-30% of female genital malignant tumors. In recent years the incidence of cancer is rising, and it has entered the top ten malignant tumors of women. Endometrial cancer mainly occurs in postmenopausal women, more than 90% of the disease occurs over 50 years of age. The main risk factors are diabetes, obesity, hypertension, and tamoxifen history. It is often found early for the postmenopausal vaginal bleeding as the main complaint. The development of laparoscopy is changing with each passing day. Childers and others applied laparoscopy in 1992. Laparoscopic surgery has become one of the most important methods for the treatment of gynecologic malignancies. The feasibility and safety of laparoscopy in the treatment of endometrial cancer has been recognized. Compared with the laparotomy, the number of lymph nodes, the amount of bleeding, the postoperative recovery, the shorter hospitalization days, and the intrauterine number of patients in the uterus are compared with those of the laparotomy. Membrane cancer is one of the most advantageous treatments. After laparoscopic surgery for endometrial carcinoma, the pelvic and peritoneal drainage tubes are often placed to avoid postoperative pelvic effusion and postoperative lymphatic cyst formation. In recent years, studies have shown that the operation of gynecologic malignant tumors can not be placed after the closure of the retroperitoneum and the preventive application of antiprophylaxis. The drainage tube not only does not increase the incidence of postoperative complications, but also reduces the anxiety of the patients, reduces the nursing staff to the drainage tube, and reduces the infection rate of the drainage. Objective: for endometrial cancer patients, pelvic endometrium carcinoma was performed by laparoscopic surgery, and pelvic drainage was placed and no pelvic cavity was placed after the operation. Two kinds of drainage methods were used to observe the incidence of postoperative complications in the two groups, especially the formation of symptomatic lymphocests and pelvic infection. The feasibility and advantages of no pelvic drainage after laparoscopic surgery for endometrial carcinoma were discussed. Methods: from 06 months of 2015 to 06 months in 2016, the pathology of the second Hospital of Shandong University was diagnosed as intrauterine. The patients with membrane carcinoma were divided into two groups: Laparoscopic endometrium carcinoma staging operation and open retroperitoneum during operation. Two groups were routinely placed in pelvic and abdominal drainage tube after operation. The other group was called drainage group; the other group did not place pelvic drainage after operation and closed the trocar hole routinely, called no drainage group. The age of the patients, the stage of tumor, pathological class were recorded. Type, operation time, lymph node metastasis, records of postoperative hospital days, catheter extraction time, postoperative recovery time of gastrointestinal function, incidence of postoperative complications such as fever, infection, formation of lympho cysts, incidence of symptomatic lymphatic cysts, retention of urine, formation of deep venous thrombosis of the lower extremity, and preoperative and postoperative albumin A total of 72 cases of effective cases were recorded in a total of 72 cases, including 32 cases without drainage group, 40 cases in drainage group, age of two groups, stage of tumor, disease, and disease. There was no significant difference in the type of lymph node metastasis, the operation time in the drainage group was (203.45 + 42.67) min, the operation time in the non drainage group was (197.38 + 22.67) min, and there was no significant difference between the operation time of the drainage group and the drainage group, and the average hospitalization period of the drainage group was (10.48 + 4.01) days after the drainage group, and the operation time of the drainage group was (10.48 + 4.01) days, and the operation time of the drainage group was (10.48 + 4.01) days. The average hospitalization period of the drainage group was (7.78 + 2.7) days after operation. The average hospitalization period after operation in the non drainage group was significantly lower than that of the drainage group (t=3.26, P=0.0017, P0.05). The difference between preoperative and postoperative albumin was (9.6 + 3.24) g/L in the drainage group and the difference between preoperative and postoperative albumin was (3.76 + 1.48) g/L without drainage group. The difference between preoperative and postoperative albumin was significantly lower than that in the drainage group (t=9.43, P=0.0000, P0.05), the incidence of lymphatic cysts, the incidence of symptomatic lympho cysts and fever, and there was no significant difference between the two groups (P0.05). Conclusion: for patients undergoing endoscopy for endometrial carcinoma under abdominal endoscopy, the hemostasis is thorough. In the case, the pelvic cavity drainage tube can not be placed, and the drainage is obviously better than the drainage. The advantages are as follows: no increase in the incidence of typical postoperative complications of lymphatic cysts, no increase in the incidence of symptomatic lymphatic cysts, no increase in the incidence of pelvic infection and fever, and no drainage, obviously relieved. The negative emotion of the patients relieved the psychological burden and anxiety of the patients after operation; without the pelvic drainage tube, it reduced the change of the drainage tube, extubation and nursing work, alleviated the workload of the medical and nursing staff, did not place pelvic drainage after operation, shortened the time of hospitalization, and did not place pelvic drainage after the operation, and avoided the puncture of the drainage tube. It also reduces the secondary pelvic infection and puncture infection caused by the placement of the pelvic drainage tube; no drainage tube stimulates the pelvic bladder and iliac vessels; it is beneficial to the recovery of bladder function and the peritoneum of the pelvic vessels; the cost of drainage tube and drainage bag, nursing cost, and postoperative nutrition are omitted. The relative reduction of support decreased the total hospitalization cost of patients, and the drainage tube was not placed to reduce the incidence of hypoalbuminemia.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R737.33

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