发布时间:2021-04-22 09:35:58 来源: 浏览次数:436
《中国实用妇科与产科杂志》2020年10月 第36卷 第10期
妇科恶性肿瘤盆腔淋巴结切除术后淋巴囊肿诊治 专家共识(2020年版)
中国医师协会微无创医学专业委员会、中国妇幼保健协会放射介入专业委员会
关键词:
盆腔淋巴囊肿;诊断;治疗;预防;共识
文章编号:
中图分类号:R711.73 文献标志码:A
参 考 文 献
[1] Gasparri ML,Ruscito I,Bolla D,et al.The efficacy of fibrin seal? ant patches in reducing the incidence of lymphatic morbidity af? ter radical lymphadenectomy:a meta-analysis[J].Int J Gynecol Cancer,2017,27(6):1283-1292. [2] Tam KF,Lam KW,Chan KK,et al.Natural history of pelvic lym? phocysts as observed by ultrasonography after bilateral pelvic lymphadenectomy[J].Ultrasound Obstet Gynecol,2008,2(1):87-90. [3] 吴琨,章文华,张蓉.219例子宫癌根治术的并发症分析[J].中 华肿瘤杂志,2006,28(4):316-319. [4] Benito V,Romeu S,Eaparza M,et a1.Safety and feasibility analy? sis of laparoscopic lymphadenectomy in pelvic gynecologic ma? lignancies:a prospective study[J].Int J Gynecol Cancer,2015, 25(9):1704-1710. [5] Park NY,Seong WJ,Chong GO,et al.The effect of nonperitoniza? tion and laparoscopic lymphadenectomy for minimizing the inci? dence of lymphocyst formation after radical hysterectomy for cer? vical cancer[J].Int J Gynecol Cancer,2010,20(3):443-448. [6] 顾乔,迟池,奚玲,等.早期宫颈癌患者术后盆腔淋巴囊肿形 成的因素分析[J].临床肿瘤学杂志,2020,25(6):558-562. [7] 潘明霞,王颖梅,闫晔,等.子宫内膜癌术后盆腔淋巴囊肿危 险因素分析[J]. 中国实用妇科与产科杂志,2017,4(33):428-432. [8] 张冬萍,牛星燕,余婷,等.妇科恶性肿瘤术后淋巴囊肿发生 及合并感染的相关因素及疗效分析[J].国际妇产科学杂志, 2020,47(2):155-158. [9] 潘明霞,王颖梅,闫晔.子宫内膜癌患者术后盆腔淋巴囊肿感 染相关因素及最佳引流时间[J]. 中华医学杂志,2017,97 (23):1765-1768. [10] 汪军坚,王春兰,张婉平,等.宫颈癌患者术后淋巴囊肿感染 的临床分析[J].中华医院感染学杂志,2016,26(15):3533- 3535. [11] Ma X,Wang Y,Fan A,et al.Risk factors,microbiology and management of infected lymphocyst after lymphadenectomy for gynecologic malignancies[J].Arch Gynecol Obstet,2018,12:298(6):1195-1203.
[12] 卢淮武,林仲秋,周晖,等.盆腔淋巴结切除术后盆腔淋巴囊 肿形成与防治[J].中国妇产科临床杂志,2007,8(4):308- 310. [13] 周红,单家治. 负压引流预防盆腔淋巴结清扫术后淋巴囊 肿[J].实用妇产科杂志,2003,19(5):298-299. [14] Kim JK,Jeong YY,Kim YH,et al.Postoperative pelvic lympho? cele:treatment with simple percutaneous catheter drainage[J]. Radiology,1999,212(2):390-394. [15] 程莉,赵志华,王海霞,等.经阴道超声盆腔淋巴囊肿诊断及 介入治疗[J].中华实用诊断与治疗杂志,2010,24(6):582- 583. [16] Klode J,Klotgen K,Korber A,et al. Polidocanol foam sclero? therapy is a new and effective treatment for post-operative lym? phorrhea and lymphocele[J].J Eur Acad Dermatol Venereol, 2010,24(8):904-909. [17] Akhan O,Karcaaltincaba M,Ozmen MN,et al.Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles[J].Cardiovasc Intervent Ra? diol,2007,30(2):237-240. [18] Karcaaltincaba M,Akhan O.Radiologic imaging and percutane? ous treatment of pelvic lymphocele[J].Eur J Radiol,2005,55 (3):340-354. [19] Baek Y,Won JH,Chang SJ,et al.Lymphatic embolization for the treatment of pelvic lymphoceles:preliminary experience in five patients[J].J Vasc Interv Radiol,2016,27(8):1170-1176. [20] Nadolski GJ,Chauhan NR,Itkin M. Lymphangiography and lymphatic embolization for the treatment of refractory chylous ascites[J].Cardiovasc Intervent Radiol,2018,41(3):415-423. [21] Chu HH,Shin JH,Kim JW,et al.Lymphangiography and lym? phatic embolization for the management of pelvic lymphocele after radical prostatectomy in prostatic cancer[J].Cardiovasc Intervent Radiol,2019,42(6):873-879. [22] Kim J,Won JH.Percutaneous treatment of chylous ascites[J]. Tech Vasc Interv Radiol,2016,19(4):291-298. [23] 许志辉.超声引导下介入疗法治疗盆腔恶性肿瘤术后淋巴 囊肿的效果与安全性分析[J].中国超声医学杂志,2019,35 (6):528-530. [24] 王华.滑石粉治疗盆腔淋巴结清扫术后淋巴囊肿[J].现代 妇产科进展,2008,17(11):874-874. [25] Stukan M,Dudziak M.Successful treatment of a large symptom? atic lympliocyst with percutaneus drainage and repeated io? dopovidone sclerotherapy[J].Eur J Gynaecol Oncol,2014,35 (4):456-457. [26] 乔柱,刘孝伟,马琦,等.CT引导下注射沙培林治疗盆腔淋 巴囊肿临床观察[J].山东医药,2015,55(26):55-56. [27] Rivera M,Marcen R,Burgos J,et al.Treatment of posttransplant lymphocele with povidone- iodine sclerosis:long- term follow-up[J].Nephron,1996,74(2):324-327. [28] 顾永忠,张向宁. 妇科盆腔淋巴结清扫术后淋巴囊肿的防 治[J].中国实用妇科与产科杂志,2008,24(9):713-714. [29] 宋立人,洪恂,丁绪亮,等.现代中药学大词典[M].北京:人民卫生出版社,2001:117,788. [30] 曹培勇,周丽,鲁娟,等.大黄芒硝外敷联合超声介入治疗宫 颈癌术后盆腔淋巴囊肿疗效观察[J]. 现代中西医结合杂 志,2017,26(23):2572-2574. [31] Nogami Y,Banno K,Adachi M,et al.Profiling of the causative bacteria in infected lymphocysts after lymphadenectomy for gy? necologic cancer by pyrosequencing the 16S ribosomal RNA gene using next- generation sequencing technology[J].Infect Dis Obstet Gynecol,2019,2019:9326285. [32] 王延洲,梁志清.妇科恶性肿瘤盆腔淋巴清扫后淋巴囊肿处 理[J].中国实用妇科与产科杂志,2016,32(11):1052-1057. [33] Akhan O,Karcaaltincaba M,Ozmen MN,et al.Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles[J].Cardiovasc Intervent Ra? diol,2007,30(2):237-240. [34] 华克勤,徐焕,薛晓红,等.腹腔镜超声刀在盆腔淋巴结清扫 术中的应用价值[J]. 中国实用妇科与产科杂志,2006,22 (4):297-298. [35] Lu HW,Zhou H,Peng YP,et al.Influences of lymphatic vessel ligation in pelvic lymphadenectomy on postoperative lympho? cyst formation- a randomized controlled trial[J].Ai Zheng, 2009,28(11):1193-1197. [36] Tsuda N,Ushijima K,Kawano K,et al.Prevention of lympho? cele development in gynecologic cancers by the electrothermal bipolar vessel sealing device[J].J Gynecol Oncol,2014,25 (3):229-235. [37] Kim YH,Shin HJ,Ju W,et al.Prevention of lymphocele by us? ing gelatin- thrombin matrix as a tissue sealant after pelvic lymphadenectomy in patients with gynecologic cancers:a pro? spective randomized controlled study[J].J Gynecol Oncol, 2017,28(3):e37. [38] Charoenkwan K,Kietpeerakool C.Retroperitoneal drainage ver? sus no drainage after pelvic lymphadenectomy for the preven? tion of lymphocyst formation in women with gynaecological ma? lignancies[J].Cochrane Database Syst Rev,2017,29(6):CD007387. [39] Yamamoto R,Saitoh T,Kusaka T,et al.Prevention of lympho? cyst formation following systematic lymphadenectomy[J].Jpn J Clin Oncol,2000,30(9):397-400. [40] 王珮瑶,张丹晔,刘娟娟,等.阴道断端半开放缝合对淋巴结 清扫术后盆腔淋巴囊肿预防作用研究[J].中国实用妇科与 产科杂志,2019,35(1):107-113. [41] Fujiwara K,Kigawa J,Hasegawa K,et al.Effect of simple omen? toplasty and omentopexy in the prevention of complications af? ter pelvic lymphadenectomy[J].Int J Gastrointest Cancer, 2003,13(1):61-66. [42] 高娜娜,焦今文,初慧君,等.奥曲肽对女性盆腔恶性肿瘤术 后淋巴渗出及淋巴囊肿形成的影响[J].山东医药,2018,58 (18):66-68. (2020-09-20 收稿)
重点提示
介入治疗是盆腔淋巴囊肿治疗的主要方法,推荐影像学检查评估盆腔淋巴囊肿穿刺的路径及安全性。
超声引导下经皮穿刺聚桂醇硬化疗法为盆腔淋巴囊肿的首选治疗方法。
聚桂醇硬化治疗的原理及特点 :
聚桂醇注入囊腔后,使囊内损伤的毛细淋巴管产生严重的炎性反应及瘢痕化,从而使淋巴管微小漏口及囊壁粘连以致完全闭合,并与囊壁内所有的淋巴上皮细胞充分接触,使其迅速凝固变性,从而达到治疗效果。