Fuller T Florian, Kang Sang-Mo, Hirose Ryutaro, Feng Sandy, Stock Peter G, Freise Chris E
Department of Urology, Charité Hospital, Humboldt-University Berlin, Germany.
J Urol. 2003 Jun;169(6):2022-5. doi: 10.1097/01.ju.0000063800.44792.61.
Laparoscopic surgery has become widely accepted for the treatment of lymphoceles following kidney transplantation. In this single center study we retrospectively reviewed our results of the surgical management of post-transplant lymphoceles, assessing indication and outcome of laparoscopic versus open drainage.
The records of 60 patients who underwent surgical treatment for a symptomatic lymphocele following kidney transplantation or combined kidney/pancreas transplantation were retrospectively reviewed.
Between 1995 and 2002, 1,836 patients received a kidney transplant at the University of California San Francisco. In 60 patients (3.3%) a symptomatic lymphocele developed and either laparoscopic (20) or open drainage (40) was completed. The conversion rate from laparoscopic to open drainage was 16.5%. The most common indications for open lymphocele drainage were noninfectious wound complications (13 patients) and a high risk of vessel or ureter injury (8) due to proximity of the lymphocele to hilar structures. Additional surgery on the graft was required in 5 patients. Intraoperative blood loss was significantly lower in the laparoscopy group. Median hospital stay was 1 day in the laparoscopy group versus 4 days in the open drainage group. No perioperative complications were observed in either group. After a median followup of 38 months, 2 patients in each treatment group had a symptomatic recurrence.
Although both surgical approaches are safe and effective, laparoscopic drainage should remain the method of choice for the treatment of post-transplant lymphocele. However, open drainage should be performed in patients with wound complications and in those with a small lymphocele adjacent to vital renal structures.
腹腔镜手术已被广泛应用于肾移植术后淋巴囊肿的治疗。在这项单中心研究中，我们回顾性分析了肾移植术后淋巴囊肿手术治疗的结果，评估了腹腔镜引流与开放引流的适应证及疗效。
回顾性分析60例因肾移植或肾/胰联合移植术后出现症状性淋巴囊肿而接受手术治疗患者的病历资料。
1995年至2002年期间，1836例患者在加利福尼亚大学旧金山分校接受了肾移植手术。其中60例（3.3%）出现了症状性淋巴囊肿，分别接受了腹腔镜引流（20例）或开放引流（40例）。腹腔镜转为开放引流的比例为16.5%。开放淋巴囊肿引流最常见的适应证是非感染性伤口并发症（13例）以及由于淋巴囊肿靠近肾门结构而导致血管或输尿管损伤风险高（8例）。5例患者需要对移植肾进行额外手术。腹腔镜组术中失血量明显较少。腹腔镜组中位住院时间为1天，而开放引流组为4天。两组均未观察到围手术期并发症。中位随访时间为38个月后, 每个治疗组均有2例患者出现症状复发。
虽然两种手术方法均安全有效，但腹腔镜引流仍应作为肾移植术后淋巴囊肿治疗的首选方法。然而，对于有伤口并发症的患者以及淋巴囊肿靠近重要肾结构且较小的患者，应采用开放引流。
