Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan.
Department of Obstetrics and Gynecology, National Hospital Organization Saitama Hospital, Saitama, Japan.
Int J Gynaecol Obstet. 2021 Jun;153(3):438-442. doi: 10.1002/ijgo.13507. Epub 2020 Dec 21.
To determine the efficacy of drainage following pelvic lymph node (PLN) dissection, especially for cases involving laparoscopic surgery.
In this retrospective study, 368 patients with malignant gynecological tumors who underwent systemic PLN dissection at Keio University Hospital between January 2012 and October 2018 were enrolled. Drainage tubes were placed in the retroperitoneal fossa in all patients. Medical records were used for data collection.
Laparoscopy was performed on 81 patients, and laparotomy was performed on 287 patients. In the laparoscopy group, tubes were removed 1 day post surgery. In the laparotomy group, tubes were removed 1 day post surgery in 167 patients and 4 days post surgery in 120 patients. Compared with the laparotomy group, we determined the laparoscopy group to have a significantly lower prevalence of lymphocyst (6.2% vs 20.2%, p = 0.002) but a similar prevalence of lymphedema (4.9% vs 5.2%), and symptomatic lymphocyst (2.5% vs 4.5%). The two laparotomy groups did not differ significantly with respect to the prevalence of lymphedema (4.8% vs 5.8%), lymphocyst (20.4% vs 20.0%), or symptomatic lymphocyst (4.2% vs 5.0%).
Our results suggest that routine drainage should be omitted, especially in cases involving laparoscopic surgery.
确定盆腔淋巴结（PLN）清扫术后引流的效果，特别是对于腹腔镜手术的情况。
本回顾性研究纳入了 2012 年 1 月至 2018 年 10 月期间在庆应义塾大学医院接受全身 PLN 解剖的 368 例恶性妇科肿瘤患者。所有患者均在腹膜后放置引流管。收集病历数据。
81 例患者接受了腹腔镜手术，287 例患者接受了剖腹手术。在腹腔镜组中，术后 1 天拔除引流管。在剖腹组中，167 例患者术后 1 天拔除引流管，120 例患者术后 4 天拔除引流管。与剖腹组相比，我们发现腹腔镜组的淋巴囊肿发生率明显较低（6.2%比 20.2%，p=0.002），但淋巴水肿的发生率相似（4.9%比 5.2%），且症状性淋巴囊肿的发生率也相似（2.5%比 4.5%）。两组剖腹手术患者的淋巴水肿发生率（4.8%比 5.8%）、淋巴囊肿发生率（20.4%比 20.0%）或症状性淋巴囊肿发生率（4.2%比 5.0%）均无显著差异。
我们的结果表明，特别是对于腹腔镜手术，应常规省略引流。
