Application Value Of Pelvic Drainage Tube In Prevention Of Lymphatic Cyst Formation After Lymph Node Dissection

Objective:To evaluate the effects of retroperitoneal drainage versus no drainage and different pelvic drainage tube on the incidence of lymphatic cyst after pelvic lymph node dissection in patients with gynecologic malignancies and to rank the curative effect of different drainage methods in order to clarify the best one or to further clarify that if a drainage tube is necessary to the prevention of postoperative lymphatic cyst formation in patients with gynecologic malignancies.Methods:Randomized controlled trials(RCTs)published in databases such as Medline,EMBASE,Cochrane Library,CBM,CNKI,and PUBMED,until October 31,2017,which comparing the effectiveness of different drainage modalities for preventing lymphatic cysts were researched.Two reviewers independently screened and extracted the information based on a predesigned data extraction table and independently assessed the quality of all included studies according to the Cochrane Handbook for Assessment of Systematics(Review Manager 5.3)。Disagreements were resolved by third party discussion.Data Processing: 1.Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphatic cyst formation in patients with gynecologic malignancies: Stata software was used for data processing and Rev Man 5.3 software was used to visualize the data analysis results.2.Different pelvic drainage tube for gynecologic malignancies in patients with postoperative lymphatic cyst formation prevention effect of Net Meta-analysis of data processing: R software was used for data processing and analysis,and the visualization of the results.Result:1.Retroperitoneal drainage versus no drainage after pelvic lymphadenectomy for the prevention of lymphatic cyst formation in patients with gynecologic malignancies: A total of seven articles were included,involving 819 patients.Meta-analysis showed that: there are no significant difference between the lymphatic cyst formation rate of gynecologic malignant tumor patients with drainage and no drainage [OR = 1.16(95% CI: 0.79 ~ 1.70,P = 0.44)].2.Different pelvic drainage tube for gynecologic malignancies in patients with postoperative lymphatic cyst formation prevention effect of Net Meta-analysis of data processing: A total of eight articles were included,involving 889 patients.Meta-analysis showed that: Compared transvaginal drainage with negative pressure,there were no significant difference with abdominal drainage with passive pressure(OR=0.74,95%CI=0.13,4.17),transvaginal drainage with passive pressure(OR=0.29,95%CI=0.04,1.89),abdominal drainage with passive pressure(OR=0.23,95%CI=0.01,4.82)and without drainage(OR=0.17,95%CI=0.02,1.31)。And just like above comparison,there were no significant difference between any other pairwise comparison of these different interventions.Conclusion:Firstly,retroperitoneal tube drain placement has no benefit in prevention of lymphatic cyst formation after pelvic lymphadenectomy in patients with gynecologic malignancies.Secondly,the incidence of lymphatic cyst after lymphadenectomy for gynecologic malignancies was significantly different between different drainage methods(A negative vaginal drainage,B negative abdominal drainage,C vaginal general drainage,D general drainage through the abdomen,E no drainage).No significant difference in the comparison.That is to say,the findings support the notion that in conventional gynecological malignancies,drainage may not be required after an open peritoneum without extensive bleeding or fluid exudation.