Smyth G P, Beitz G, Eng M P, Gibbons N, Hickey D P, Little D M
Department of Urology and Transplantation, Beaumont Hospital, Dublin 9, Ireland.
J Urol. 2006 Sep;176(3):1069-72. doi: 10.1016/j.juro.2006.04.014.
Between January 1993 and December 2002 a total of 1,289 renal transplants were performed at our institution. Symptomatic post-transplant lymphocele presenting as increased creatinine and hydronephrosis of the allograft was recorded at 0.02%. Records of the 27 patients in whom symptomatic lymphocele developed and of those who underwent contralateral kidney transplant (control group) were compared to determine the long-term effects of lymphocele formation on allograft function.
A total of 37 procedures for the treatment of lymphocele were performed in 24 patients. Open marsupialization (12) and laparoscopic marsupialization (3) procedures were performed as primary treatments. Two patients underwent repeat open marsupialization. Aspiration and percutaneous catheter drainage were performed as a primary procedure in 7 and 1 cases, respectively. Percutaneous nephrostomy was required in 4 cases before definitive treatment.
The mean time to development of a lymphocele was 121 days (range 35 to 631). Symptomatic lymphocele did not require treatment in 3 patients. Of 19 patients undergoing primary marsupialization, recurrence in 2 necessitated repeat surgery. However, aspiration and percutaneous drainage proved to be definitive in only 2 cases. In total 8 patients required more than 1 procedure. At a mean followup of 63 months (SD 30.3) 21 allografts continued to function with a mean serum creatinine of 152 mumol/l (SD 67.9). In the control group 3 patients experienced graft failure and mean serum creatinine was 154 mumol/l (SD 51.9). Five patients died in the lymphocele group, 2 with functioning grafts compared to 4 deaths in the control group.
Surgical marsupialization is the preferred primary treatment for symptomatic lymphocele and is associated with excellent long-term allograft outcome.
1993年1月至2002年12月期间，我院共进行了1289例肾移植手术。有症状的移植后淋巴囊肿表现为移植肾功能肌酐升高和肾盂积水，记录发生率为0.02%。比较27例发生有症状淋巴囊肿患者和接受对侧肾移植患者（对照组）的记录，以确定淋巴囊肿形成对移植肾功能的长期影响。
24例患者共进行了37次淋巴囊肿治疗手术。开放造袋术（12例）和腹腔镜造袋术（3例）作为主要治疗方法。2例患者接受了重复开放造袋术。抽吸术和经皮导管引流术分别作为主要手术用于7例和1例患者。4例患者在确定性治疗前需要进行经皮肾造瘘术。
淋巴囊肿形成的平均时间为121天（范围35至631天）。3例患者有症状的淋巴囊肿无需治疗。19例接受初次造袋术的患者中，2例复发需要再次手术。然而，抽吸术和经皮引流术仅在2例中被证明是确定性的。总共有8例患者需要进行不止一次手术。平均随访63个月（标准差30.3）时，21例移植肾仍在发挥功能，平均血清肌酐为152μmol/L（标准差67.9）。对照组中有3例患者移植肾失败，平均血清肌酐为154μmol/L（标准差51.9）。淋巴囊肿组有5例患者死亡，2例移植肾仍在发挥功能，而对照组有4例死亡。
手术造袋术是有症状淋巴囊肿的首选主要治疗方法，且与优异的移植肾长期预后相关。
