| Objective: Cervical cancer,endometrial cancer,ovarian cancer are three common major malignant tumors in the female reproductive system,increasing with years and having a younger and younger trend.Gynecological malignancy surgery generally needs pelvic lymphadenectomy,but pelvic lymph nodes are associated with many blood vessels and nerves,contorts circuity,distribution density.Thus pelvic lymphadenectomy may gain greater risk of intraoperative damage to blood vessels,lymphatic vessels and nerves,resulting in intraoperative and postoperative complications.Peripheral nerve,including obturator nerve,is a more advanced tissue,very fragile,vulnerable to the injury of mechanical and electrical stimulation.Pelvic lymphadenectomy is easy to get obturator nerve damage during the treatment of gynecological malignant tumor,resulting in pain,numbness,movement disorders of lower limb and the emergence of leg inside skin sensory disturbances.The repair of nerve damage will be much more difficult than other tissues,because nerve damage will change a lot.Gangliosides is a family of heterogeneous sheath glycolipids including sialic acid,and is an important component of most mammalian cell membranes,which can effectively inhibit neuronal apoptosis,promote the repair of damaged parts and its functional recovery.Among them,monosialotetrahexosyl gangliosides(GM1)is the main species of mammal gangliosides.The discovery and successful extraction of GM1 provides a new way directly for the treatment of peripheral nerve injury.It provides the improvement of various morphology and the biochemical,physiological,behavioral parameters of peripheral nerves fundamentally,through the biotechnological technology,then accelerates the repair,so as to maximize the recovery of the original function of the peripheral nerve ultimately.The aim of this study was to observe the related factors of obturator nerve injury after pelvic lymphadenectomy in gynecological malignancies and to do the preliminary evaluation of monosialoglycans ganglioside(GM1)on the repairment of obturator nerve injury.The study will provide a new idea for the treatment of obturator nerve injury after gynecological malignancy surgery.Methods:1 The related complications of 652 cases of gynecological malignancies were observed from April 2015 to December 2016 in our hospital.The related clinical data of 652 patients were analyzed statistically,including the age,body mass index,tumor type,medical complications,preoperative abdominal surgery history,operation method,intraoperative blood loss,the resected pelvic lymph node numbers,the positive numbers of pelvic lymph nodes,whether or not doing abdominal aortic lymph node resection at the same time,or doing neoadjuvant chemotherapy.To study the related factors of obturator nerve injury.2 74 cases of gynecologic malignant patients with obturator nerve injury symptoms,were randomly divided into observation group(34 cases)and control group(40 cases),who had undergone gynecological surgery,incuding pelvic lymph nodes resection.The observation group was given routine therapy together with GM-1 intravenous drip,and the control group was given routine therapy only.The improvement of lower limb pain,numbness,abnormal skin temperature,muscle strength recovery,were recorded and analyzed in two groups during medication.The average time of different symptoms recovery were recorded and analyzed as well.3 StatisticsThe clinical data and postoperative follow-up data were recorded into Excel spreadsheet and established a database.SPSS 22.0 statistical software was used in data analysis.The association between clinical related factors and obturator nerve injury was tested by squared inspection(including the age,body mass index,tumor type,medical complications,preoperative abdominal surgery history,operation method,intraoperative blood loss,the resected pelvic lymph node numbers,the positive numbers of pelvic lymph nodes,whether or not doing abdominal aortic lymph node resection at the same time,or doing neoadjuvant chemotherapy).The univariate factors associated with obturator injury were placed in the Logistic regression model as independent variables,and the obturator nerve injury and obturator nerve injury were analyzed as dependent variables.The effect of GM-1 and the recovery rate of obturator nerve were expressed as the percentage.The result of drug effect was tested by four table x squared inspection.The average recovery time of different obturator nerve injury symptoms were expressed as mean ± standard deviation(x+S)and tested by t-test.P<0.05 was looked as signif-icance.Results:1 The complications of pelvic lymph node dissection in gynecological malignant tumor treatmentThe highest occurrence of complication was postoperative infection after pelvic lymph node dissection,followed by lymph cyst.The incidence of obturator nerve injury and lower limb edema were higher.The incidence of chyle leakage was lower.2 The single factor analysis of obturator nerve injury1)Age and body mass index: age,body mass index(obesity)and the occurrence of obturator injury did not find a significant correlation,the difference was not statistically significant(P> 0.05).2)whether or not with medical complications and whether or not with abdominal surgery history: The medical complications and preoperative abdominal surgery history didn’t increase the risk of obturator nerve injury.The difference was not statistically significant(P> 0.05)3)Gynecological malignancies and operation methods(abdominal surgery and laparoscopy): Cervical cancer,endometrial cancer,and laparoscopy had a close correlation with obturator nerve injury(P <0.05)4)The numbers of dissected pelvic lymph nodes and the positive numbers of pelvic lymph node: the occurrence of obturator nerve injury was associated with the number of dissected pelvic lymph nodes(P<0.05),but no correlation with the positive numbers of pelvic lymph node.The difference was not significant(P>0.05).5)whether or not doing abdominal aortic lymph node resection at the same time,or doing neoadjuvant chemotherapy: Both had no significant correlation with the occurrence of obturator nerve injury(P>0.05).6)The amount of intraoperative blood loss: the greater the amount of intraoperative bleeding more likely to occur obturator nerve injury,the difference was statistically significant(P <0.05).3 Multivariate analysis of obturator nerve injuryMultivariate stepwise regression analysis showed that there were significant differences in the number of surgical procedures(laparotomy,laparoscopic),intraoperative blood loss,pelvic lymph node dissection and obturator injury(P<0.05),which is an independent risk factor for obturator nerve injury.4 Short-term efficacy of GM-1 in the treatment of obturator nerve injuryThere was no significant difference in the recovery of muscle strength and skin sensory disturbances between two groups(P>0.05),but the improvement of pain and numbness in treatment group was significantly better than the control group,and the difference was statistically significant(P <0.05).5 Long-term effect of GM-1 on obturator nerve injuryTwo groups of patients were followed up for 1 year.There was no significant difference between two groups about the average recovery time of different obturator nerve injury symptoms(P> 0.05).Conclusion:1 The most common complication is postoperative infection in gynecological malignant tumor after pelvic lymph node dissection,followed by lymphatic cysts.2 The incidence of obturator nerve injury is higher in cervical cancer and endometrial cancer than in ovarian cancer,in laparoscopy than in abdominal surgery.The more dissected pelvic lymph nodes,the more intraoperative blood lose,the easier to get obturator nerve injury.3 Monosialoglycans ganglioside(GM-1)promote the short-term recovery efficacy of obturator nerve injury after pelvic lymph node dissection in the gynecological malignant tumor.But the long-term effect is not clear,needs further investigation. |
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