Neu B, Gauss G, Haase W, Dentz J, Husfeldt K J
Abteilung für Strahlentherapie und Radioonkologie, St.-Vincentius-Krankenhaus Karlsruhe.
Strahlenther Onkol. 2000 Jan;176(1):9-15. doi: 10.1007/pl00002305.
The treatment of persistent postoperative lymphatic fistulas or lymphoceles is often a problem. Approximately 2% of patients will develop lymphatic fistula after vascular surgery. This can require a long lasting conservative therapy. If spontaneous cure fails, a second operation with wound revision becomes necessary. We studied low-dose percutaneous radiotherapy to be used as an alternative treatment in addition to conservative or surgical therapy.
Between 1989 and 1998 29 patients (25 with lymphatic fistulas, 4 with lymphoceles) received radiation therapy. Depending on the depth of the fistula 27 patients were treated with electrons (7 to 18 MeV). Two other patients suffering of retroperitoneal lymphoceles received a treatment with photons (15 MV). In all patients the fractionation was 4- to 5 x 1.0 Gy/week and the dose ranged from 3 to 12 Gy depending upon the onset of the radiation therapy effect.
In 27 of 28 evaluable patients a complete disappearance of the fistula or lymphocele was achieved by radiation during therapy or shortly afterwards. In 1 case no benefit was observed after a dose of 11 Gy. This patient required further surgery with wound exploration.
Low dose percutaneous radiotherapy (up to 10 to 12 Gy) is effective to heal lymphatic fistulas and lymphoceles without complications. Individual dosage is required because doses even lower than 10 Gy may be effective. Radiation can be effective even after a failed conservative therapy or instead of surgery.
术后持续性淋巴瘘或淋巴囊肿的治疗常常是个难题。血管手术后约2%的患者会发生淋巴瘘。这可能需要长期的保守治疗。如果自发愈合失败，则需要进行二次手术并修订伤口。我们研究了低剂量经皮放射治疗作为保守或手术治疗之外的替代治疗方法。
1989年至1998年间，29例患者（25例淋巴瘘，4例淋巴囊肿）接受了放射治疗。根据瘘管深度，27例患者接受电子束治疗（7至18兆电子伏特）。另外2例腹膜后淋巴囊肿患者接受光子治疗（15兆伏）。所有患者的分割剂量为每周4至5次，每次1.0戈瑞，剂量根据放射治疗效果的出现情况在3至12戈瑞之间。
在28例可评估患者中，27例在治疗期间或之后不久通过放射治疗使瘘管或淋巴囊肿完全消失。1例患者在接受11戈瑞剂量后未观察到效果。该患者需要进一步进行伤口探查手术。
低剂量经皮放射治疗（最高10至12戈瑞）可有效治愈淋巴瘘和淋巴囊肿且无并发症。需要个体化给药，因为甚至低于10戈瑞的剂量也可能有效。即使保守治疗失败或可替代手术时，放射治疗也可能有效。
