Franchi M, Ghezzi F, Zanaboni F, Scarabelli C, Beretta P, Donadello N
Department of Obstetrics and Gynecology, University of Varese-Ospedale di Circolo, Italy.
Obstet Gynecol. 1997 Oct;90(4 Pt 1):622-7. doi: 10.1016/s0029-7844(97)00359-1.
To compare closure and nonclosure of the peritoneum at radical abdominal hysterectomy and pelvic node dissection with respect to postoperative morbidity.
Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned randomly to have a standard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed. Adjuvant radiotherapy was given to patients with risk factors. The postoperative incidence of lymphocysts (within 8 weeks from the operation and after 1 year) and infection-related and non-infection-related complications were analyzed.
One hundred twenty subjects were enrolled, of whom 59 had peritoneal closure and 61 did not. Both groups were similar with regard to age, weight, nodes removed, nodal metastases, operative time, type of surgery, need for transfusion, and incidence of postoperative radiotherapy. The median follow-up was 36 months (range 11-72). Eleven patients died, four because of treatment-related complications. The amount of drainage was significantly higher in the closed group than in the unclosed group (median 740 mL, range 50-5980 versus median 340 mL, range 40-4000; P < .005). The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks (17 of 59 versus 15 of 6, respectively), at 8 weeks (eight of 56 versus ten of 61, respectively), and after 1 year (one of 21 versus four of 22, respectively). No difference was found between closed and open groups in terms of symptomatic lymphocysts (one of 59 versus two of 61, respectively), wound and pelvic infection (seven of 59 versus 11 of 61, respectively), febrile morbidity (two of 59 versus 11 of 61, respectively), and obstruction (zero of 59 versus one of 61, respectively).
Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications.
比较根治性腹式子宫切除术和盆腔淋巴结清扫术中腹膜关闭与不关闭对术后发病率的影响。
对接受根治性腹式子宫切除术及Piver-RutledgeⅡ型或Ⅲ型淋巴结清扫术的子宫癌患者，随机分为两组，一组进行盆腔和壁层腹膜的标准关闭并放置T形引流管，另一组则使腹膜敞开但关闭阴道并放置两根腹腔引流管。对有危险因素的患者给予辅助放疗。分析术后（术后8周内及1年后）淋巴囊肿的发生率以及感染相关和非感染相关并发症的发生情况。
共纳入120名受试者，其中59名进行了腹膜关闭，61名未进行腹膜关闭。两组在年龄、体重、切除的淋巴结数量、淋巴结转移情况、手术时间、手术类型、输血需求及术后放疗发生率方面相似。中位随访时间为36个月（范围11 - 72个月）。11名患者死亡，4名死于与治疗相关的并发症。关闭组的引流量明显高于未关闭组（中位数740 mL，范围50 - 5980 mL，而未关闭组中位数为340 mL，范围40 - 4000 mL；P < 0.005）。无症状淋巴囊肿的发生率在关闭组和开放组中相似，术后2周时分别为59例中的17例和61例中的15例，8周时分别为56例中的8例和61例中的10例，1年后分别为21例中的1例和22例中的4例。在有症状的淋巴囊肿（分别为59例中的1例和61例中的2例）、伤口和盆腔感染（分别为59例中的7例和61例中的11例）、发热性疾病（分别为59例中的2例和61例中的11例）以及肠梗阻（分别为59例中的0例和61例中的1例）方面，关闭组和开放组之间未发现差异。
根治性腹式子宫切除术和淋巴结清扫术中不关闭腹膜并无危害，且与感染或粘连相关并发症的发生率增加无关。
