Clinical Significance Of Posterior Pelvic Peritoneum Unsuture In Radical Hysterectomy

Background: Cervix cancer is one of the most common malignant tumors in female reproductive system in China. It is believed that laparotomic radical hysterectomy combined with pelvic lymphadenectomy is the optimal management for early-stage invasive cervix cancer. The wide excisional extent of radical hysterectomy could results in a large wounded surface and makes the operational procedure much complicate. Lymphocyst is one of the postoperative complications due to the exudation from wound surface and lymph fluid recirculation disorder. With the development of those lymphocysts, they often cause venous recirculation disorder in lower extremity and ureter obstruction which are troublesome to clinicians. For a long time, posterior pelvic peritoneum suture after radical hysterectomy had been considered to be a standard operative procedure. It was believed that posterior pelvic peritoneum suture could reduce the probability of abdominopelvic cavity infection, intestinal adhesion and incisional hernia. However, some researchers proposed that it was unnecessary to suture the posterior pelvic peritoneum after radical hysterectomy and might not increase the postoperative complications. The advantages of unsuture approach include shorter operation time, low incidence of postoperative fever, less postoperative drainage flow and lymphocyst formation.Objective: To discuss whether posterior pelvic peritoneum suture in the radical hysterectomy can shorten postoperative fever time, decrease drainage flow of pelvic and abdominal cavity in 72 hours and lower the incidence of lymphocysts.Methods: A retrospective analysis was conducted including 289 cases accepted radical hysterectomy between 2004.1～2007.12. The sample was divided into two groups. Control group: 142 cases accepted radical hysterectomy with posterior pelvic peritoneum unsuture. Experimental group: 147 cases accepted radical hysterectomy with posterior pelvic peritoneum suture. Compared the differences of general postoperative condition, operation time, postoperative fever time, pelvic and abdominal cavity drainage flow in 72 hours and the incidence of lymphocyst between two groups. The data was handled by SPSS 13.0. The constituent ratio was analyzed by variance analysis and the average value of two groups was analyzed by T-test.Results:1.Mean operation time:Control group:152±57.9 minutes; experimental group:148±55.6 minutes.There was no significant statistical difference between two groups (P>0.05).2.Mean postoperative anal exsufflation time: Control group: 48.4±6.4 hours; experimental group: 47.2±6.2 hours, There was no significant statistical difference between two groups (P>0.05).3.Average drainage flow in 72 hour: Control group: 760±413.2ml; Experimental group: 605±325.8ml. There was significant statistical difference between two groups (P<0.05).4.Average postoperative fever time: Control group: 6.2±2.1 days; Experimental group: 5.1±2.0 days. There was significant statistical difference between two groups (P<0.05).5.The incidence of lymphocyst: Control group: 22 cases (15.5%); experimental group: 6 cases (4.1%). There was significant statistical difference between two groups (P<0.05).Conclusions:1. Radical hysterectomy combined with posterior pelvic peritoneum unsuture didn't increase the opportunity of conglutination in the cavitas pelvis as well as other complications compared with the traditional posterior pelvic peritoneum suture procedure. On the contrary, it can shorten fever period and decrease the occurrence rate of lymphocyst.2. Posterior pelvic peritoneum suture can be omitted in the radical hysterectomy procedure.