The Relate Factors Analysis Of Lymphocele After Pelvic Lymphadenectomy In Patients With Endometrial Cancer

Objcetive 1.To investigate the incidence and risk factors of lymphocele development after pelvic lymphadenectomy.2.To investigate the incidence and risk factors of lymphocele infection development after pelvic lymphadenectomy.3.To investigate optimal timing for drainage of lymphocele infection after pelvic lymphadenectomy.4.To investigate the incidence and risk factors of existence time of lymphocele.Methods This retrospective study was carried out on 430 patients who received a pelvic lymphadenectomy with or without a para-aortic lymphadenectomy between January 2009 and December 2016,due to endometrial cancer in General hostipal of Tianjin medical university.A total of 81 patients developed lymphoceles.60 patients only need conservative treatment,21 patients treatmented with antibiotics and/or puncture drainage.Data analysis application SPSS19.0 statistical software.Results 1.The incidence of lymphocele after a pelvic lymphadenectomy with or without a para-aortic lymphadenectomy was 18.84%.Single factor analysis indicated that scope of lymphadenectomy,FIGO stage,the number of pelvic lymphadenectomy,the number of para-aortic lymphadenectomy were associated with lymphocyst formation(P=0.001,P=0.026,P=0.019,P=0.024).Multiple factors Logistic analysis through the adjustment of the factors showed a pelvic lymphadenectomy with a para-aortic lymphadenectomy was the independent risk factors for lymphocyst formation(P=0.033),and the risk is 2.187 times compared of pelvic lymphadenectomy alone.2.Lymphocele mainly occurs within 2 months after surgery.Single factor analysis indicated diameter of lymphocele and the distribution lymphocele were associated with existence time of lymphocele(P1=0.005,P2=0.006;P1=0.054,P2=0.016).Multiple factors Cox survival analysis through the adjustment of the factors showed diameter of lymphocele ?3.8cm was the independent risk factors for existence time of lymphocyst.3.The number of para-aortic lymphadenectomy,the number of WBC,Hb,PLT were associated with the diameter of the lymphcele's diamter(P = 0.017,P = 0.019,P = 0.009).4.The incidence of lymphocele infection was 4.42%(19/430).Single factor analysis indicated diameter of lymphocele and postoperative anemia were associated with lymphocele formation(P<0.001,P=0.011).Multiple factors Logistic analysis through the adjustment of the factors showed diameter of lymphocele ?5cm was the independent risk factors for lymphocyst infection(P<0.001),and the risk is 17.596 times compared of lymphocele <5cm.5.4 cases' Bacterial culture(including drainage liquid culture and/or blood culture)were positive in 15 patients.3 samples are Gram positive coccus,Slow staphylococcus,dung enterococcus,staphylococcus aureus respectively.1 sample is Gram-negative bacillus sewer enterobacter compound.6.The treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage(P=0.020).And the diameter of lymphocele treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage(P=0.046).However,for severe cases which needed drainage,initiating the drainage by day 3 significantly shortened the total treatment period compared with cases started on or after day 4(P = 0.045).Conclusion 1.Lymphocele is the most commonly postoperative complication after a pelvic lymphadenectomy with para-aortic lymphadenectomy in endometrial cancers.To identify the Clear surgical indications,to avoid unnecessary extensive lymphoectomy is useful to help reduce the incidence of lymphocele.2.The incidence of lymphcele mainly occurred within 2 months after operation.The diameter of the lymphcele and existing range affect the prognosis of lymphocele.And pay attention to the state of internal environment of the lymphcele patients will improving the prognosis of lymphocele.3.If lymphocele has been formed,correction of the poor state of blood is necessary,and the large lymphocele need Close follow-up.These methods are useful to help reduce the incidence of lymphocele infection.4.In the event of lymphcele infection,antibiotics to cover both gram-positive bacteria and gram-negative bacteria and anaerobic bacteria should be used.When drainage is required in addition to antibiotics,the earlier the drainage is performed,the shorter the treatment period is.