宫颈癌根治术后盆腔淋巴囊肿形成影响因素研究进展

Research Advances in Risk Factors for Pelvic Lymphocele Formation Following Radical Hysterectomy for Cervical Cancer

摘要: 宫颈癌根治联合盆腔淋巴结清扫是宫颈癌标准根治方案，术中淋巴循环受损、淋巴液回流障碍易诱发盆腔淋巴囊肿，其发病率报道差异较大，轻症可自行吸收，重症可引发疼痛、感染，延缓术后康复。本文系统梳理宫颈癌术后盆腔淋巴囊肿的形成机制、好发部位，从手术操作、患者自身基础状态、肿瘤病理与术后辅助治疗三大维度归纳囊肿形成相关影响因素：开腹手术、单极电刀、扩大淋巴结清扫范围、淋巴结转移、糖尿病、术后低蛋白/贫血、高FIGO分期、术后放化疗为高危因素；超声刀、Ligasure、术中喷洒铜绿假单胞菌注射液、合理引流管理为保护性因素。现有研究对年龄、高血压等因素结论尚存分歧。临床可通过术前基础疾病纠正、术中精细化淋巴管处理、术后规范引流与营养支持的全程管理模式降低淋巴囊肿发生风险，为该病预防与个体化干预提供循证依据。

Abstract: Radical hysterectomy combined with pelvic lymphadenectomy serves as the standard radical regimen for cervical cancer. Intraoperative injury to lymphatic circulation and disordered lymphatic reflux readily induce pelvic lymphocysts, whose reported incidence varies widely. Mild lymphocysts can be absorbed spontaneously, while severe ones may cause pain and infection and delay postoperative rehabilitation. This paper systematically sorts out the formation mechanisms and predilection sites of pelvic lymphocysts following cervical cancer surgery. Relevant influencing factors for cyst formation are summarized from three dimensions: surgical procedures, patients’ baseline physical conditions, tumor pathology and postoperative adjuvant therapy. Laparotomy, monopolar electrosurgery, extended lymph node dissection scope, lymph node metastasis, diabetes, postoperative hypoalbuminemia/anemia, advanced FIGO stage and postoperative chemoradiotherapy are high-risk factors; ultrasonic scalpel, LigaSure, intraoperative spray of Pseudomonas aeruginosa injection and standardized drainage management are protective factors. Conclusions of existing studies regarding factors such as age and hypertension remain controversial. A full-cycle management model including preoperative correction of underlying diseases, refined intraoperative lymphatic vessel handling, standardized postoperative drainage and nutritional support can reduce the risk of lymphocyst occurrence, providing evidence-based references for disease prevention and individualized clinical intervention.