A Comparative Study Comparing Drainage Or Not For Laparoscopic Endometrial Carcinoma Surgery

BackgroundEndometrial carcinoma(EC)is a group of epithelial malignant tumors primary in the endometrium,which is one of the three most common malignant tumors of female genital tract.The high incidence age is 58-61 years old.It accounts for about 7%of the total number of female cancer patients.Patients with endometrial carcinoma accounts for 20%-30%of the female genital tract malignant tumor patients.In recent years,the incidence of the endometrial carcinoma is on the rise.Endometrial cancer has entered the top 10 of women malignant tumor.Endometrial cancer occurs mainly in postmenopausal women.More than 90%of endometrial carcinoma patients are older than 50 years old.Risk factors mainly include diabetes,obesity,high blood pressure and tamoxifen use,etc.The early detection in patients with endometrial carcinoma is postmenopausal vaginal bleeding for complain.Laparoscopy is a way of surgery which has developed rapidly in recent years.In 1992,Childers et al applied laparoscopic surgery to endometrial cancer staging surgery.Now,laparoscopic surgery has become one of the important methods for the treatment of gynecologic malignant tumors.The feasibility and security of laparoscopic surgery in the treatment of endometrial carcinoma has been recognized.Compared with open operation,laparoscopy has the advantage of less bleeding?resecting more lymph nodes?fast postoperative recovering and the sharter average hospitalization days.In order to avoid postoperative pelvic cavity accumulates fluid and the formation of a lymphocele after surgery,need basin abdominal cavity drainage tube often needs to be placed after laparoscopic endometrial cancer staging surgery.In recent years,the research points out that,without shutting down the retroperitoneum and under the condition of the prophylactic use of antibiotics,the drainage tube need not to be placed after gynecologic malignant tumors which do not increase the incidence of postoperative complications?lighten the mood of anxiety in the patients?reduce nursing of drainage tube by medical staff and reduce the infection rate of the drainage pipe.Objective:For patients with endometrial cancer undergoing laparoscopic hysterectomy +double adnexectomy + pelvic lymph node cleaning,postoperative respectively placing pelvic drainage and not placed pelvic drainage,weobserved the incidence of postoperative complications,like symptomatic lymph cyst and pelvic infection,in two groups.We discuss the laparoscopic endometrial cancer resetion.Method:From December 2015 to December 2016,the patients,with IND-B in the second Hospital of Shandong university,were divided into two groups,which were divided into two groups according to their parents' choice and were performed laparoscopic hysterectomy + double adnexectomy + pelvic lymph node cleaning + abdominal aorta lymph nodes cleaning,and posterior peritoneum was opened in operation.Postoperative,two drainage tubes of pelvic and abdominal cavity were placed routinely which was called the group with drainage tube.The drainage tube of pelvic and abdominal cavity do not place in another group after surgery,which was called the group without drainage tube.We record the patient's age?tumor staging?pathological type?operation time?lymph node metastasis,and emphatically record Postoperative hospital stay?retention of urine?thrombosis of lower extremity and comparison of albumin before and after operation.Collating data,measurement data used Mean ± SD,and using t test and chi square test analyze data.Result:In this study,a total of 72 cases were recorded,the group with drainage tube containing 32 cases,the group without drainage tube containing 40 cases.Two groups of patient's age?tumor staging?pathological type and lymph node metastasis is similar.The average operation time of the group with drainage tube was(203.45±42.67)min.The average operation time of the group without drainage tube was(197.38±22.67)min.The average operation time of the drainage group and the non drainage group have no significant difference;The average length of hospital stay of the group with drainage tube was(10.48±4.01)days.The average length of hospital stay of the group without drainage tube was((7.78±2.7))days.The average length of hospital stay was not significantly lower than that of the drainage group(t=3.26,P=0.0007,P<0.05)..The difference between preoperative and postoperative albumin was(9.6±3.24)g/L.The preoperative and postoperative albumin difference was not in the drainage group was(3.76±1.48)g/L.The difference of albumin before and after operation was not significantly lower than that in the drainage group(t=9.43,P=0.0000,P<0.05).The rate of formation of lymphatic cyst?the rate of formation of symptomatic cysts?fever and infection did not have significant difference(P>0.05).Conclusion:For patients undergoing laparoscopic staging of endometrial cancer,the postoperative drainage was not compared with the drainage of the abdominal cavity?the incidence of postoperative lymphatic cyst was similar and The incidence of symptomatic cysts without drainage group was significantly lower than that in the drainage group.The incidence of fever and pelvic infection was not lower than that of the group with drainage group.And non Drainage tube reduced the time of surgery?shorten the length of hospital stay?reduced the psychological burden of patients and reduced the workload of medical staff.For patients with endometrial cancer,after laparoscopic staging of endometrial carcinoma,in the case of complete hemostasis,no drainage was better than placement drainage.