妇科恶性肿瘤盆腔淋巴结清扫术中淋巴管结扎不同方式对术后淋巴囊肿形成的影响

Impact of Different Ways of Lymphatic Ligation in Pelvic Lymph Node Dissection on Formation of Post-operative Lymphocyst in Patients with Gynecological Cancer

[目的]探讨妇科恶性肿瘤手术中采用不同方式处理盆腔淋巴结断端术后盆腔淋巴囊肿发生情况,寻找更有效预防淋巴囊肿的手术方式。[方法]351例妇科恶性肿瘤患者行腹式盆腔淋巴结清扫术,其中136例应用双极电凝闭合(双极组),115例应用单极电刀凝切(单极组),100例采用丝线结扎(丝线结扎组),比较3种手术方式术后盆腔淋巴囊肿的发生情况。[结果]3种手术方式切除淋巴结数量及疾病种类比较无统计学差异。术后淋巴囊肿发生率双极组为6.6%(9/136),单极组为15.7%(18/115),丝线结扎组为24.0%(24/100),双极组术后淋巴囊肿的发生率明显低于单极组、丝线结扎组,差异有统计学意义(P<0.05)。双极组盆腔淋巴囊肿多较小,症状轻,无需处理,待自行吸收;单极组有2例囊肿较大,症状重,经住院治疗并行穿刺引流及无水酒精凝固后囊肿渐消;丝线结扎组有7例出现较大囊肿并有临床症状,均经住院穿刺引流及无水酒精凝固后渐好转。[结论]妇科恶性肿瘤盆腔淋巴结清扫术中使用双极电凝闭合淋巴管残端能更有效预防术后盆腔淋巴囊肿的形成。

[Purpose lTo investigate the incidence of lymphocyst after different ways of lymphatic ligation in pelvic lymph node dissection for gynecologic malignancies, and to find a more effec- tive way to prevent the formation of post-operative lymphatic cyst. [ Methods ] Three hundred and fifty-one patients underwent abdominal pelvic lymphadenectomy.Among them, 136 cases under- went bipolar eleetrocoagulation （bipolar group）, 115 cases underwent monopolar electrocoagula- tion （monopolar group）, and 100 cases underwent silk ligature（silk group）. Occurrence of pelvic lymphocyst was compared among the 3 groups. [ Results ~ No difference was found in the number of lymph node and the type of disease among the 3 groups. The incidence of pelvic lymphocyst was 6.6%（9/136） in bipolar group ,15.7% （18/115） in monopolar group,and 24.0%（24/100） in silk group. The oceurenee of lymphocyst in bipolar group was significantly lower than that in monopolar group,or in silk group. In the bipolar group,the lymphocyst was smaller,with mild symptoms,and could be self-absorbed. Two patients in monopolar group had large cysts,with severe symptoms, and the cysts disappeared after drainage and ethanol solidification. Seven pa- tients had large cysts and clinical symptoms in silk group ,and their symptoms were improved after treated with percutaneous drainage and ethanol solidification. [Conclusion~ Bipolar electro- coagulation for closure of lymphatic stump in pelvic lymphadenectomy could be more effectively prevent the formation of post-operative pelvic lvmphocvst.