本文選題：子宮內(nèi)膜癌 + 腹腔鏡　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：背景:子宮內(nèi)膜癌(Endometrial Carcinoma,EC)是原發(fā)于子宮內(nèi)膜的一組上皮性惡性腫瘤,是女性生殖道常見的三大惡性腫瘤之一,約占女性癌癥總數(shù)的7%,占女性生殖道惡性腫瘤的20%-30%,近年發(fā)病率有上升趨勢,已經(jīng)進(jìn)入女性前十大惡性腫瘤之列。子宮內(nèi)膜癌主要發(fā)生在絕經(jīng)后婦女,90%以上發(fā)病于50歲以上。高危因素主要有糖尿病、肥胖、高血壓及三苯氧胺服用史等,常因絕經(jīng)后陰道流血為主訴而被早期發(fā)現(xiàn)。腹腔鏡技術(shù)的發(fā)展日新月異,Childers等人于1992年將腹腔鏡手術(shù)應(yīng)用于子宮內(nèi)膜癌分期手術(shù),現(xiàn)在,腹腔鏡手術(shù)已經(jīng)成為治療婦科惡性腫瘤的重要方法之一。腹腔鏡手術(shù)治療子宮內(nèi)膜癌,其可行性和安全性已獲得公認(rèn)。與開腹手術(shù)相比,切除淋巴結(jié)數(shù)量多,出血量少,術(shù)后恢復(fù)快,平均住院天數(shù)短,成為子宮內(nèi)膜癌頗具優(yōu)勢的治療方式之一。腹腔鏡下子宮內(nèi)膜癌分期手術(shù)之后,為避免術(shù)后盆腔積液及術(shù)后淋巴囊腫的形成,常放置盆腹腔引流管,而近年來研究指出,在不關(guān)閉后腹膜而且預(yù)防性應(yīng)用抗生素的情況下,婦科惡性腫瘤術(shù)后可不放置引流管,不僅不會(huì)增加術(shù)后并發(fā)癥的發(fā)生率,而且會(huì)減輕患者的焦慮心情,減少醫(yī)護(hù)人員對(duì)引流管的護(hù)理工作,減少引流口的感染率。目的:對(duì)于子宮內(nèi)膜癌患者行腹腔鏡下子宮內(nèi)膜癌分期手術(shù),術(shù)后分別給予放置盆腔引流與不放置盆腔引流兩種術(shù)式,觀察兩組的術(shù)后并發(fā)癥的發(fā)生率,尤其是有癥狀的淋巴囊腫的形成,盆腔感染等發(fā)生。探討腹腔鏡下子宮內(nèi)膜癌術(shù)后不放置盆腔引流的可行性及優(yōu)點(diǎn)。方法:自2015年06月至2016年06月將山東大學(xué)第二醫(yī)院病理確診為子宮內(nèi)膜癌的患者分為兩組,行腹腔鏡下子宮內(nèi)膜癌分期手術(shù),術(shù)中開放后腹膜。一組術(shù)后常規(guī)放置盆腹腔引流管兩根,稱為放置引流組;另外一組術(shù)后不放置盆腔引流,常規(guī)關(guān)閉trocar孔,稱為不放置引流組。記錄患者的年齡、腫瘤的分期、病理類型、手術(shù)時(shí)間,淋巴結(jié)轉(zhuǎn)移情況,著重記錄患者的術(shù)后住院天數(shù)、尿管拔除時(shí)間、術(shù)后胃腸功能恢復(fù)時(shí)間、術(shù)后并發(fā)癥的發(fā)生率,如發(fā)熱、感染、淋巴囊腫的形成率、有癥狀的淋巴囊腫的形成率、尿潴留、下肢深靜脈血栓的形成、術(shù)前術(shù)后白蛋白的對(duì)比,整理記錄的數(shù)據(jù),計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差(Mean±SD)表示,利用t檢驗(yàn)、卡方檢驗(yàn)等進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:在本試驗(yàn)中,總共記錄了有效病例共72例,其中不放置引流組病例32例,放置引流組病例40例,兩組患者的年齡、腫瘤的分期、病理類型、淋巴結(jié)轉(zhuǎn)移情況均無顯著性差異;放置引流組的手術(shù)時(shí)間為(203.45±42.67)min,不放置引流組的手術(shù)時(shí)間為(197.38±22.67)min,不放置引流組的手術(shù)時(shí)間與放置引流組無顯著性差異;放置引流組的術(shù)后平均住院周期是(10.48±4.01)天,不放置引流組的術(shù)后平均住院周期是(7.78±2.7)天,不放置引流組的術(shù)后平均住院周期要明顯低于放置引流組(t=3.26,P=0.0017,P0.05);放置引流組的術(shù)前與術(shù)后白蛋白差值是(9.6±3.24)g/L,不放置引流組的術(shù)前與術(shù)后白蛋白差值是(3.76± 1.48)g/L,不放置引流組術(shù)前與術(shù)后白蛋白差值明顯低于放置引流組(t=9.43,P=0.0000,P0.05);淋巴囊腫的發(fā)生率、有癥狀的淋巴囊腫的發(fā)生率及發(fā)熱、感染兩組對(duì)比均沒有顯著性差異(P0.05)。結(jié)論:對(duì)于行腹腔鏡下子宮內(nèi)膜癌分期手術(shù)的患者,在止血徹底的情況下,可以不放置盆腹腔引流管,不放置引流明顯優(yōu)于放置引流,其優(yōu)點(diǎn)有以下幾點(diǎn):沒有增加術(shù)后典型并發(fā)癥淋巴囊腫的發(fā)生率,也沒有增加有癥狀的淋巴囊腫的發(fā)生率;沒有增加盆腔感染及發(fā)熱的發(fā)生率;不放置引流,明顯緩解了患者的負(fù)面情緒,減輕了患者術(shù)后的心理負(fù)擔(dān)及焦慮情緒;不放置盆腔引流管,減少了對(duì)引流管的換藥、拔管及護(hù)理工作,減輕了醫(yī)護(hù)人員的工作量;術(shù)后不放置盆腔引流,縮短了住院時(shí)間;術(shù)后不放置盆腔引流,避免了引流管對(duì)穿刺口的刺激,也減少了因?yàn)榉胖门枨灰鞴芏鸬睦^發(fā)的盆腔感染及穿刺口感染;沒有了引流管對(duì)盆腔膀胱及髂血管的刺激,有利于膀胱功能恢復(fù)及盆腔內(nèi)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、護(hù)理等費(fèi)用,術(shù)后營養(yǎng)支持相對(duì)減少,總體減少了患者的住院總費(fèi)用;不放置引流管,減少了低白蛋白血癥的發(fā)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.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R737.33

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