Benedetti-Panici P, Maneschi F, Cutillo G, D'Andrea G, di Palumbo V S, Conte M, Scambia G, Mancuso S
Department of Obstetrics and Gynecology, Catholic University of the Sacred Heart, Rome, Italy.
Gynecol Oncol. 1997 Jun;65(3):478-82. doi: 10.1006/gyno.1997.4648.
To evaluate the clinical effectiveness of retroperitoneal drainage following lymphadenectomy in gynecologic surgery.
One hundred thirty-seven consecutive patients undergoing systematic lymphadenectomy for gynecologic malignancies were randomized to receive (Group A, 68) or not (Group B, 69) retroperitoneal drainage. The pelvic peritoneum and the paracolic gutters were not sutured after node dissection. Perioperative data and complications were recorded.
Clinical and surgical parameters were comparable in the two groups. Postoperative hospital stay was significantly shorter in Group B (P < 0.001), whereas the complication rate was significantly higher in Group A (P = 0.01). This was mainly due to a significant increase in lymphocyst and lymphocyst-related morbidity. Sonographic monitoring for lymphocyst showed free abdominal fluid in 18% of drained and 36% of not-drained patients (P = 0.03). Symptomatic ascites developed in 2 drained (3%) and 3 not-drained (4%) patients (NS), respectively.
Prophylactic drainage of the retroperitoneum seems to increase lymphadenectomy-related morbidity and postoperative stay. Therefore, routine drainage following lymphadenectomy seems to be no longer indicated when the retroperitoneum is left open.
评估妇科手术中淋巴结清扫术后腹膜后引流的临床效果。
137例因妇科恶性肿瘤接受系统性淋巴结清扫术的连续患者被随机分为两组，A组68例接受腹膜后引流，B组69例不接受腹膜后引流。淋巴结清扫术后不缝合盆腔腹膜和结肠旁沟。记录围手术期数据和并发症情况。
两组的临床和手术参数具有可比性。B组术后住院时间显著缩短（P < 0.001），而A组并发症发生率显著更高（P = 0.01）。这主要是由于淋巴囊肿及与淋巴囊肿相关的发病率显著增加。超声监测淋巴囊肿发现，引流组18%的患者和未引流组36%的患者有腹腔游离液（P = 0.03）。有症状的腹水分别在2例（3%）引流患者和3例（4%）未引流患者中出现（无统计学差异）。
预防性腹膜后引流似乎会增加与淋巴结清扫相关的发病率和术后住院时间。因此，当腹膜后保持开放时，淋巴结清扫术后常规引流似乎不再必要。
