本文選題：淋巴結(jié)清掃術(shù) + 淋巴囊腫�。� 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討婦科惡性腫瘤行盆腔淋巴結(jié)清掃術(shù)后淋巴囊腫形成及感染的相關(guān)因素和治療措施。方法:收集山西省腫瘤醫(yī)院婦二科自2013年6月~2016年6月因婦科腫瘤行盆腔淋巴結(jié)清掃術(shù)的患者,對符合入組條件的498例患者進行回顧性分析,根據(jù)有無淋巴囊腫形成分為淋巴囊腫組與無淋巴囊腫組。分析患者年齡、腫瘤類型、有無糖尿病史、淋巴管斷端閉合方式、后腹膜關(guān)閉與否、引流管引出方式、術(shù)后出現(xiàn)貧血、血小板低下、低蛋白血癥、肝功能異常以及術(shù)后病理情況、留置引流管時間、術(shù)后24小時引流量等因素與淋巴囊腫形成和感染的相關(guān)性。采用X 2檢驗、Fisher確切概率法及l(fā)ogistic回歸模型進行統(tǒng)計學(xué)分析。結(jié)果:1.采用X 2檢驗進行組間比較顯示:盆腔淋巴囊腫的形成與淋巴結(jié)清掃術(shù)中淋巴管斷端閉合方式、后腹膜閉合與否、引流管引出方式、術(shù)后低蛋白血癥、肝功能異常及切除淋巴結(jié)數(shù)目、留置引流管時間、術(shù)后24小時引流量相關(guān)(P0.05);而與年齡、腫瘤類型、有無糖尿病史、術(shù)后貧血、術(shù)后血小板低下及轉(zhuǎn)移淋巴結(jié)數(shù)目無明顯相關(guān)(P0.05)。2.采用Logistic回歸進行相關(guān)性分析結(jié)果顯示:(1)淋巴管斷端閉合方式、后腹膜處理方式及切除淋巴結(jié)數(shù)目是淋巴囊腫形成的獨立危險因素(P0.05),而術(shù)后低蛋白血癥、肝功能異常、留置引流管時間并不是淋巴囊腫形成的獨立危險因素(P0.05);(2)采用超聲刀閉合淋巴管斷端與銳、鈍性撕脫法相比,淋巴囊腫形成風(fēng)險增加1.423倍(OR值為1.423);(3)后腹膜開放屬淋巴囊腫形成的保護性因素(B值為-0.747);(4)淋巴結(jié)切除數(shù)目越多,淋巴囊腫形成的風(fēng)險越大,切除淋巴結(jié)數(shù)目每增加10個,淋巴囊腫形成的風(fēng)險增加1.396倍(OR值為1.396)。3.淋巴囊腫感染最主要的致病菌為大腸埃希菌,占57.69%。采用X 2檢驗分析淋巴囊腫感染與淋巴囊腫直徑、單雙側(cè)發(fā)生、引流管引出方式、留置引流管時間密切相關(guān)(P0.05)。采用Fisher確切概率法比較單純抗生素(有效率為28.57%)與聯(lián)合超聲引導(dǎo)下淋巴囊腫穿刺引流術(shù)(有效率為71.43%)治療淋巴囊腫感染的療效,差異具有統(tǒng)計學(xué)意義(X 2=12.857,P0.05)。結(jié)論:1.采用超聲刀閉合淋巴管斷端可增加術(shù)后淋巴囊腫發(fā)生率;2.后腹膜開放可降低淋巴囊腫發(fā)生率;3.切除淋巴結(jié)數(shù)目越多,淋巴囊腫形成的風(fēng)險越大;4.淋巴囊腫感染主要致病菌為大腸埃希菌,且與囊腫體積較大(5cm以上)、雙側(cè)發(fā)生、引流管經(jīng)陰道引出、留置引流管時間長密切相關(guān);抗生素治療聯(lián)合超聲引導(dǎo)下穿刺引流術(shù)是治療淋巴囊腫感染的有效措施。
[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.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R737.3

【參考文獻】

相關(guān)期刊論文 前10條

1 汪軍堅;王春蘭;張婉平;方靜;傅志勤;;宮頸癌患者術(shù)后淋巴囊腫感染的臨床分析[J];中華醫(yī)院感染學(xué)雜志;2016年15期

2 葛倩倩;陳秀芹;;術(shù)中開放后腹膜對婦科惡性腫瘤患者術(shù)后淋巴囊腫形成的影響[J];中國現(xiàn)代醫(yī)學(xué)雜志;2016年13期

3 代俊利;李杰;楊松梅;劉雷;楊寶英;趙澤金;張艷利;段雪光;;中藥外敷加口服治療宮頸癌盆腔淋巴結(jié)清掃術(shù)后淋巴液滲出及預(yù)防淋巴囊腫形成的研究[J];臨床和實驗醫(yī)學(xué)雜志;2015年18期

4 郭敏;朱波;沈曉露;黃凌霄;葉琳;葉天真;;婦科惡性腫瘤術(shù)后化療后淋巴囊腫并發(fā)感染25例臨床分析[J];中華全科醫(yī)學(xué);2015年07期

5 張躍;龔光明;劉蓉;徐海波;;宮頸癌患者術(shù)后盆腔淋巴囊腫感染的調(diào)查分析[J];中華醫(yī)院感染學(xué)雜志;2014年13期

6 姚遠洋;李云;王悅;李藝;唐軍;王建六;魏麗惠;;婦科腫瘤腹膜后淋巴結(jié)切除術(shù)后淋巴囊腫形成的相關(guān)因素分析[J];現(xiàn)代婦產(chǎn)科進展;2013年01期

7 韓璐;蘆艷麗;謝群;王建東;;微波聯(lián)合中藥灌腸治療宮頸癌術(shù)后盆腔淋巴囊腫療效觀察[J];腫瘤學(xué)雜志;2013年01期

8 韓麗萍;侯娜;高美;史惠蓉;李留霞;趙麗娟;;盆腔淋巴結(jié)清掃術(shù)后盆腔淋巴囊腫預(yù)防探討[J];國際婦產(chǎn)科學(xué)雜志;2012年02期

9 杜曉紅;謝娟;胡鳳俠;王勤;;中藥熱敷治療宮頸癌根治術(shù)后并發(fā)淋巴囊腫的療效觀察[J];現(xiàn)代腫瘤醫(yī)學(xué);2010年07期

10 梁志清;;婦科腫瘤腹腔鏡診治存在的若干問題及爭論[J];中華婦幼臨床醫(yī)學(xué)雜志(電子版);2010年03期

，

本文編號：1799674