Analysis Of Factors Related To Formation And Infection Of Lymphocyst And The Discussion Of Its Prevention And Treatment After Pelvic Lymphadenectomy

Objective: The goal of this study was to discuss the related factors of formation and infection of pelvic lymhocele,the effective treatment and to evaluate the effectiveness of semi –open suturation of vaginal stump to prevent pelvic lymphocele after pelvic lymphadenectomy during gynecologic cancer surgery.Methods: This study is a retrospective study.348 patients of cervic cancer and endometrial cancer who underwent pelvic lymphadenectomy and/or para-aortic lymphadenectomy from January 2012 to September 2018 were divided into two group according to the presence of lymphocele and the infection of lymphocele,the two group were compared for age,type of tumor,FIGO stage,presence of diabetes story,whether adjuvant chemotherapy/radiotherapy or not,surgery time,harvested lymph node,drainage time,range of lymphadenectomy,whether abdominal operation history or not.The patients were also divided into two group according to the suturation of vaginal stump.The two group were compared for the surgery time,harvested lymph node,drainage time,albumin level,hemoglobin content,the incidence of lymphocele and symptomatic lymphocele.Results: 1.Single factor analysis showed that advanced FIGO stage(III-IV),adjuvant radiotherapy/chemotherapy after operation,pelvic and para-aortic lymphadenectomy,abdominal operation history,closed vaginal stump were risk factors for lymphocele formation(P <0.05),and presence of diabetes history,lymphocele diameter(>5cm)have a correlation to lymphocele infection(P <0.05).Logistic regression correlation analysis showed that advanced FIGO stage(III-IV),closed vaginal stump were independent risk factors for lymphocele formation(P <0.05),and presence of diabetes history,lymphocele diameter(>5cm)were also independent risk factors for lymphocele infection(P <0.05).2.16 pathogenic strains were found from the bacteria culture of blood and lymphocele fluid of 45 cases of infective patients.The most common pathogenic bacteria were Escherichia coli(43.75%)and Staphylococcus Aureus(18.75%).3.There were no differences between two groups with respect to surgery time,harvested lymph node,drainage time,albumin level,hemoglobin content(P>0.05).The incidence of lymphocele and symptomatic lyphocele in semi-open group wassignificantly lower than that in closed group(35.3%versus79.3%,3.9%versus19.5%,P<0.05),the average diameter of lymphocele in semi-open group was also significantly lower than that in closed group(4.1cm versus5.9cm,P<0.05).4.Among 47 cases of symptomatic lymphocele,46 cases were reduced or disappeared through ultrasound /CT guided percutaneous drainage combined with antibiotics,showing an efficiency of 97.9%.Conclusion: 1.The incidence of lymphocele could be increased with advanced FIGO stage(III-IV)and closed vaginal stump.2.The risk of lymphocele infection could be increased with presence of diabetes history and large lymphocele diameter(>5cm).The most common pathogenic bacteria of lymphocele infection were Escherichia coli(43.75%)and Staphylococcus Aureus(18.75%).3.Ultrasound /CT guided percutaneous drainage combined with antibiotics was an effective way to treat symptomatic lymphocele.4.The result of this study indicate that the application of semi-open saturation of vaginal stump was an effective way to reduce the incidence of pelvic lymphocele after gynecologic malignancy.