妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的相关因素分析  

Risk factors of postoperative lower limb lymphedema following lymphadenectomy in gynecologic malignancies

作　　者：王健理[1] 李状[1] 蒋玲玲 姚德生[1] WANG Jianli;LI Zhuang;JIANG Lingling;YAO Desheng(Department of Gynecologic Oncology,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院妇瘤科,南宁530021

出　　处：《临床肿瘤学杂志》2021年第7期602-606,共5页Chinese Clinical Oncology

基　　金：广西壮族自治区临床重点专科建设资助项目。

摘　　要：目的探讨妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的相关危险因素,以此指导临床对术后下肢淋巴水肿的预防和治疗。方法回顾性分析2012年1月至2018年5月1489例确诊为妇科恶性肿瘤并行盆腔淋巴结清扫或切除、伴/不伴腹主动脉旁淋巴结切除或腹股沟淋巴结切除术的患者的临床病理资料,对术后下肢淋巴水肿的发生情况进行总结并分析其相关危险因素。多因素分析采用Logistic回归模型。结果纳入的1489例患者中,253例发生下肢淋巴水肿(17.0%),其中宫颈癌、子宫恶性肿瘤、卵巢恶性肿瘤术后下肢淋巴水肿的发生率分别为18.7%(150/801)、15.3%(62/404)和13.1%(32/244),不同类型肿瘤术后下肢淋巴水肿发生率的差异无统计学意义(P=0.078)。145例(57.3%)患者在术后1年内发生下肢淋巴水肿。单因素分析显示,年龄、高血压病史、淋巴结转移、FIGO分期、辅助化疗、辅助放疗和术后淋巴囊肿形成均与下肢淋巴水肿的发生有关(P<0.05);多因素分析显示,辅助放疗(HR=3.234,95%CI:2.441~4.285,P<0.001)和辅助化疗(HR=1.463,95%CI:1.005~2.128,P=0.041)是影响妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿发生的独立因素。术后下肢淋巴水肿的产生可能与放疗剂量和放疗次数有关(P<0.05)。结论妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的发生率较高,术后1年为下肢淋巴水肿发生的危险期。辅助放疗和辅助化疗能增加妇科恶性肿瘤淋巴结切除术后下肢淋巴水肿的发生风险。Objective To explore the incidence of lower limb lymphedema in patients who underwent lymphadenectomy for gynecologic cancer and to evaluate risk factors associated with lower limb lymphedema.Methods A retrospective study was performed on1489 patients with gynecologic malignancies who underwent pelvic lymphadenectomy with or without para-aortic lymphadenectomy or inguinal lymphadenectomy from January 2012 to May 2018.The intervals between surgery and diagnosis of lower limb lymphedema were calculated;the prevalence and risk factors were evaluated using Logistic proportional hazards methods.Results In the 1489 patients,the incidence of lower limb lymphedema was 17.0%(253/1489).The incidence of postoperative lower limb lymphedema was 18.7%(150/801),15.3%(62/404)and 13.1%(32/244)in cervical cancer,uterine malignant tumor and ovarian malignant tumor,respectively,and the difference had no statistic significance(P=0.078).One hundred and forty-five(57.3%)patients developed lower limb lymphedema whin 1 year after operation.Univariate analysis showed that age,hypertension,lymph node metastasis,FIGO staging,adjuvant radiotherapy and chemotherapy,as well as lymphocyst formation were found to be associated with lower limb lymphedema(P<0.05).Multivariate analysis confirmed adjuvant radiotherapy(HR=3.234,95%CI:2.441-4.285,P<0.001)and adjuvant chemotherapy(HR=1.463,95%CI:1.005-2.128,P=0.041)were independent risk factors for lower limb lymphedema.The doses and the times of radiotherapy were associated with lower limb lymphedema(P<0.05).Conclusion The incidence of lower limb lymphedema after lymphadenectomy of gynecological malignarcies is high,and the risk period of lower limb lymphedema is one year after operation.Adjuvant radiotherapy and chemotherapy can increase the risk of lower limb lymphedema after lymphadenectomy.

关 键 词：妇科恶性肿瘤 淋巴结切除术 下肢淋巴水肿 

分 类 号：R737􀆰[医药卫生—肿瘤]