Manchana Tarinee, Sirisabya Nakarin, Lertkhachonsuk Ruangsak, Worasethsin Pongkasem, Khemapech Nipon, Sittisomwong Tul, Vasuratna Apichai, Termrungruanglert Wichai, Tresukosol Damrong
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Apr;92(4):451-6.
To evaluate the incidence of long-term complications in stage IB and IIA cervical cancer patients undergoing radical hysterectomy with bilateral pelvic lymphadenectomy.
A retrospective review on 290 patients who were treated with primary type III radical hysterectomy with bilateral pelvic lymphadenectomy between January 1, 1997 and December 31, 2005. Long-term complications were classified in two categories, voiding dysfunction and complication from lymphadenectomy such as lymphocyst and lymphedema.
Forty-two patients (14.5%) required urethral catheterization more than four weeks. Only four patients (1.4%) were diagnosed as neurogenic bladder and required permanent self-catheterization. Two hundred forty eight patients (85.5%) returned to normal voiding within 1 month postoperatively. The incidence of lymphocyst was 9.3%; however, almost of them were asymptomatic and resolved spontaneously within a few months. Only four patients (1.4%) had complicated lymphocyst and required hospitalization with intravenous antibiotic and drainage procedure. Six patients (2.1%) were diagnosed as lymphedema after exclusion of deep vein thrombosis and recurrent cervical carcinoma. Pelvic lymph node metastasis and postoperative adjuvant radiation were not significant risk factors for lymphocyst and lymphedema.
Radical hysterectomy with lymphadenectomy is the treatment of choice in stage IB and IIA cervical cancer with excellent survival rate. However there are long-term complications such as voiding dysfunction, lymphocyst, and lymphedema. Although these complications are not life threatening, they can affect the quality of life.
评估接受根治性子宫切除术加双侧盆腔淋巴结清扫术的ⅠB期和ⅡA期宫颈癌患者长期并发症的发生率。
回顾性分析1997年1月1日至2005年12月31日期间接受初次Ⅲ型根治性子宫切除术加双侧盆腔淋巴结清扫术的290例患者。长期并发症分为两类，即排尿功能障碍和淋巴结清扫术相关并发症，如淋巴囊肿和淋巴水肿。
42例患者（14.5%）需要导尿超过4周。仅4例患者（1.4%）被诊断为神经源性膀胱并需要长期自行导尿。248例患者（85.5%）术后1个月内恢复正常排尿。淋巴囊肿的发生率为9.3%；然而，几乎所有患者均无症状，且在数月内自行消退。仅4例患者（1.4%）发生复杂性淋巴囊肿，需要住院接受静脉抗生素治疗及引流手术。排除深静脉血栓形成和复发性宫颈癌后，6例患者（2.1%）被诊断为淋巴水肿。盆腔淋巴结转移和术后辅助放疗并非淋巴囊肿和淋巴水肿的显著危险因素。
根治性子宫切除术加淋巴结清扫术是ⅠB期和ⅡA期宫颈癌的首选治疗方法，生存率高。然而，存在排尿功能障碍、淋巴囊肿和淋巴水肿等长期并发症。虽然这些并发症不会危及生命，但会影响生活质量。
