本文選題：子宮內(nèi)膜癌 + 淋巴結(jié)切除術(shù)　； 參考：《天津醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的1.探討影響淋巴囊腫形成相關(guān)的因素,尋找預(yù)防或減少淋巴囊腫形成的方法;2.探討影響淋巴囊腫存在時(shí)間長(zhǎng)短的相關(guān)因素,尋找縮短淋巴囊腫存在時(shí)間的方法;3.探討影響淋巴囊腫感染發(fā)生的相關(guān)因素,尋找預(yù)防或減少淋巴囊腫感染發(fā)生的方法;4.探討淋巴囊腫感染的常見病原菌以及治療方法與治療時(shí)間的關(guān)系,尋找敏感的抗生素和更合適高效的治療方法。材料方法收集2009年1月~2016年12月天津醫(yī)科大學(xué)總醫(yī)院婦產(chǎn)科行盆腔和/或腹主動(dòng)脈旁淋巴結(jié)切除的子宮內(nèi)膜癌患者430例,術(shù)后發(fā)生淋巴囊腫者81例,其中60例患者僅需保守治療,21例患者行抗生素或/和穿刺引流治療。數(shù)據(jù)分析應(yīng)用SPSS19.0統(tǒng)計(jì)軟件,淋巴囊腫及淋巴囊腫感染發(fā)生單因素檢驗(yàn)采用χ2檢驗(yàn),多因素分析采用多因素Logistic回歸分析;參數(shù)檢驗(yàn)采用t檢驗(yàn),非參數(shù)檢驗(yàn)采用Mann-Whitney U檢驗(yàn)或/和Kruskal-Wallis檢驗(yàn);淋巴囊腫存在時(shí)間相關(guān)因素的單因素分析采用Kaplan-Meier方法,經(jīng)Log-rank方法和Breslow方法檢驗(yàn),多因素分析采用Cox多因素回歸分析。結(jié)果1.子宮內(nèi)膜癌患者行盆腔和/或腹主動(dòng)脈旁淋巴結(jié)切除術(shù)后淋巴囊腫的發(fā)生率為18.84%(81/430),單因素分析發(fā)現(xiàn)淋巴結(jié)切除范圍大、FIGO分期晚期、盆腔淋巴結(jié)切除個(gè)數(shù)≥25、腹主動(dòng)脈旁淋巴結(jié)切除個(gè)數(shù)≥4與淋巴囊腫發(fā)生相關(guān)(P=0.001,P=0.026,P=0.019,P=0.024),多因素Logistic回歸分析,發(fā)現(xiàn)盆腔+腹主動(dòng)脈旁淋巴結(jié)切除是淋巴囊腫形成的獨(dú)立危險(xiǎn)因素(P=0.033),發(fā)生風(fēng)險(xiǎn)是單純盆腔淋巴結(jié)切除患者的2.187倍。2.淋巴囊腫主要發(fā)生在術(shù)后2個(gè)月內(nèi)。單因素生存分析發(fā)現(xiàn)淋巴囊腫的存在時(shí)間與淋巴囊腫的直徑、淋巴囊腫的分布(單側(cè)或雙側(cè))相關(guān)(P1=0.005,P2=0.006;P1=0.054,P2=0.016);淋巴囊腫發(fā)生在雙側(cè)時(shí)淋巴囊腫存在時(shí)間長(zhǎng),淋巴囊腫直徑≥3.8 cm時(shí)淋巴囊腫存在時(shí)間明顯延長(zhǎng),將單因素有意義的2個(gè)因素進(jìn)行Cox多因素生存分析發(fā)現(xiàn)淋巴囊腫直徑是影響淋巴囊腫存在時(shí)間長(zhǎng)短的獨(dú)立危險(xiǎn)因素。3.淋巴囊腫形成時(shí)的直徑大小與術(shù)中腹主動(dòng)脈旁淋巴結(jié)切除個(gè)數(shù),術(shù)后第一日血PLT、Hb的值相關(guān),淋巴囊腫直徑≥4.6cm組患者術(shù)中腹主動(dòng)脈旁淋巴結(jié)切除個(gè)數(shù)多,術(shù)后血PLT值低,Hb值低(P=0.017,P=0.019,P=0.009)。4.子宮內(nèi)膜癌患者行盆腔和/或腹主動(dòng)脈旁淋巴結(jié)清掃的患者術(shù)后感染淋巴囊腫的發(fā)生率為4.42%(19/430),經(jīng)單因素分析發(fā)現(xiàn)淋巴囊腫直徑≥5cm,術(shù)后貧血是淋巴囊腫感染發(fā)生的相關(guān)因素(P0.001,P=0.011),多因素Logistic回歸分析,發(fā)現(xiàn)淋巴囊腫直徑≥5 cm是淋巴囊腫感染發(fā)生的獨(dú)立危險(xiǎn)因素(P=0.001),發(fā)生風(fēng)險(xiǎn)是淋巴囊腫直徑5cm患者的17.956倍。5.送檢細(xì)菌培養(yǎng)(包括引流液培養(yǎng)和/或血培養(yǎng))的15例患者中4例陽性,3例為革蘭陽性球菌,分別為緩慢葡萄球菌、糞腸球菌、人葡萄球菌;1例為革蘭陰性桿菌陰溝腸桿菌復(fù)合型。6.在淋巴囊腫感染的治療中單純使用抗生素組較抗生素聯(lián)合穿刺引流組治療時(shí)間短(P=0.020)。并且單純使用抗生素組較抗生素聯(lián)合穿刺引流組淋巴囊腫直徑小(P=0.046)。在輔以引流治療的患者中在使用抗生素的3 d以內(nèi)給予引流者治療時(shí)間較第4 d及以后給予者治療時(shí)間縮短(P=0.045)。結(jié)論1.淋巴囊腫是子宮內(nèi)膜癌患者行盆腔和/或腹主動(dòng)脈旁淋巴結(jié)切除術(shù)后的常見并發(fā)癥,明確手術(shù)指征,避免不必要的大范圍的淋巴結(jié)清掃,將會(huì)減少淋巴囊腫的發(fā)生。2.淋巴囊腫主要發(fā)生在術(shù)后2個(gè)月內(nèi),大多數(shù)不需特殊干預(yù),淋巴囊腫的直徑和存在部位會(huì)影響淋巴囊腫的預(yù)后。術(shù)前或術(shù)后積極關(guān)注并改變患者的內(nèi)環(huán)境狀態(tài),將會(huì)影響淋巴囊腫發(fā)生時(shí)的大小,從而使得淋巴囊腫的存在時(shí)間縮短,改善患者的預(yù)后以及生活質(zhì)量。3.對(duì)于已經(jīng)形成的淋巴囊腫,積極糾正貧狀態(tài)血,對(duì)體積較大的囊腫進(jìn)行密切隨訪,將會(huì)減少淋巴囊腫感染的發(fā)生。4.一旦發(fā)生淋巴囊腫感染,以覆蓋革蘭陽性菌、革蘭陰性菌及厭氧菌的廣譜抗生素抗感染治療。對(duì)于需要輔以引流治療的患者在使用抗生素的前3 d內(nèi)給予,治療時(shí)間將會(huì)縮短。
[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.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 洪玉鋒;;不同術(shù)式治療Ⅱ期子宮內(nèi)膜癌的臨床療效[J];中國(guó)婦幼健康研究;2015年04期

2 吳毅明;;腹腔鏡手術(shù)治療早期老年子宮內(nèi)膜癌的療效觀察[J];現(xiàn)代診斷與治療;2015年14期

3 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

4 代俊利;閆雷;李金玲;楊松梅;楊寶英;劉雷;;宮頸癌術(shù)后盆腔囊腫及并發(fā)感染的危險(xiǎn)因素[J];中國(guó)老年學(xué)雜志;2015年11期

5 謝英華;郭曉紅;李秀玲;沈靖;張?jiān)破?;婦科惡性腫瘤切除術(shù)化療后淋巴囊腫感染的臨床診治[J];中華醫(yī)院感染學(xué)雜志;2015年08期

6 楊紀(jì)實(shí);周留林;周秋霞;印慧琴;王君;邵莉萍;韓克;;腹腔鏡下腹主動(dòng)脈旁淋巴結(jié)切除在子宮內(nèi)膜癌診治中的臨床研究[J];實(shí)用婦產(chǎn)科雜志;2015年03期

7 徐律;柯曉慧;黃一統(tǒng);;婦科腫瘤手術(shù)患者化療后淋巴囊腫感染預(yù)防及治療[J];中華醫(yī)院感染學(xué)雜志;2013年23期

8 張鳳逸;孫建國(guó);彭英;王廣基;;新型去勢(shì)抵抗性前列腺癌治療藥物研究進(jìn)展[J];藥學(xué)進(jìn)展;2013年05期

9 姚遠(yuǎn)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(jìn)展;2013年01期

10 楊立;張穎;趙書君;趙倩;;宮頸癌腹腔鏡下廣泛子宮切除及盆腔淋巴結(jié)清掃術(shù)中應(yīng)用可溶性止血紗布的療效分析[J];中國(guó)醫(yī)學(xué)創(chuàng)新;2012年30期

相關(guān)會(huì)議論文 前1條

1 姚遠(yuǎn)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)后淋巴囊腫的相關(guān)分析[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)婦產(chǎn)科學(xué)術(shù)會(huì)議婦科腫瘤會(huì)場(chǎng)（婦科腫瘤學(xué)組、婦科病理學(xué)組）論文匯編[C];2012年

，

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