Optimal Timing for Drainage of Infected Lymphocysts After Lymphadenectomy for Gynecologic Cancer
Optimal Timing for Drainage of Infected Lymphocysts After Lymphadenectomy for Gynecologic Cancer
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DOI：
10.1097/igc.0000000000000353
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发表时间：
2015-02-01
影响因子：
4.8
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
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作者：
Hiramatsu, Kosuke;Kobayashi, Eiji;Kimura, Tadashi
背景：淋巴囊肿（淋巴囊肿）是淋巴结切除术的常见并发症，淋巴结切除术是妇科癌症广泛使用的手术方法。在淋巴细胞感染的情况下，治疗策略，包括抗生素给药和囊肿引流的时间和持续时间，可能会因医生而异。本研究的目的是确定引流感染了对抗生素治疗耐药的细菌的淋巴细胞的最佳时机。 材料和方法：分析了 2000 年 4 月至 2012 年 8 月期间在日本大阪大阪大学医院接受妇科恶性肿瘤手术中淋巴结切除术的 1175 名患者的临床数据。结果：在 282 名出现淋巴细胞的患者 (24%) 中，35 名患者感染了淋巴细胞。分析了淋巴细胞（12%）。淋巴囊肿感染与肿瘤起源、子宫切除类型或淋巴结切除区域无关（分别为 P = 0.81、P = 0.59 和 P = 0.86）。单纯抗生素治疗的病例总治疗时间往往短于抗生素联合引流治疗的病例，但差异不显着（P=0.061）。然而，对于需要引流的重症病例，与第6天或之后开始的病例相比，第5天开始引流明显缩短了总治疗时间（P=0.042）。结论：开始淋巴细胞引流的合适时间点一直难以确定。本研究提示，对于严重的淋巴细胞感染，除了抗生素外还需要引流，越早引流，治疗时间越短。可能需要进一步的研究来决定感染淋巴细胞的其他最佳治疗策略。
Background: A lymphocyst (lymphocele) is a common complication of lymphadenectomy, which is a widely used surgical method for gynecologic cancers. In cases of infected lymphocysts, therapeutic strategies, including the timing and duration of antibiotics administration and cyst drainage, may vary depending on the physician. The aim of this study was to determine the optimal timing for drainage of lymphocysts infected with bacteria resistant to antibiotic treatment.Materials and Methods: Clinical data for 1175 patients who underwent a lymphadenectomy as part of surgery for a gynecologic malignancy between April 2000 and August 2012 at Osaka University Hospital, Osaka, Japan, were analyzed.Results: Of the 282 patients who developed a lymphocyst (24%), 35 with infected lymphocysts (12%) were analyzed. Lymphocyst infection was not associated with tumor origin, type of hysterectomy, or region of lymphadenectomy (P = 0.81, P = 0.59, and P = 0.86, respectively). The total treatment period of cases treated only with antibiotics tended to be shorter than that of cases treated with combined antibiotics and drainage, but the difference was not significant (P = 0.061). However, for severe cases which needed drainage, initiating the drainage by day 5 significantly shortened the total treatment period compared with cases started on or after day 6 (P = 0.042).Conclusions: The appropriate time point for initiating lymphocyst drainage has been difficult to determine. The present study implies that for severe lymphocyst infections, where drainage is required in addition to antibiotics, the earlier the drainage is performed, the shorter the treatment period is. Further studies may be required to decide other optimal treatment strategies for infected lymphocysts.