Möhring K, Pomer S
Urologische Abteilung, Chirurgischen Zentrums der Universität Heidelberg.
Helv Chir Acta. 1991 Sep;58(3):265-70.
The interposition of the greater omentum was used for treatment of lymphoceles in combination with peritoneal fenestration and for prevention of urinary fistulas in cases of lower pole renal artery lesions and feared ureteral necrosis as well as for protection of pyeloureterostomics and pyelovesicostomics, secondary to ureteral necrosis postrenal transplantation. Especially the combination of peritoneum fenestration with interposition of the greater omentum proved to be the procedure of choice for treatment of posttransplant lymphoceles. The incidence of lymphoceles following renal transplantation is in the range of 5-15%. Even by meticulous surgical technique--ligature of donor and recipient lymph vessels--they cannot be prevented totally since perioperative anticoagulation plays a significant role. Following unsuccessful repeated punctures for decompression, external drainage, local application of tetracycline or fibrinogen glue, internal marsupialisation to the peritoneal cavity is the established ultimate treatment. Inherent risks and difficulties of this procedure can be reduced, if peritoneal fenestration of the lymphoceles is combined with the interposition of the greater omentum. This technique described in details gave totally satisfactory results in 14 cases.
大网膜植入术用于联合腹膜开窗治疗淋巴囊肿，以及在肾下极动脉病变、担心输尿管坏死的情况下预防尿瘘，保护肾盂输尿管吻合口和肾盂膀胱吻合口，这些吻合口是肾移植术后输尿管坏死的继发病变。特别是腹膜开窗联合大网膜植入术被证明是治疗移植后淋巴囊肿的首选方法。肾移植后淋巴囊肿的发生率在5%至15%之间。即使采用精细的手术技术——结扎供体和受体淋巴管——也无法完全预防，因为围手术期抗凝起着重要作用。在反复穿刺减压失败、进行外部引流、局部应用四环素或纤维蛋白原胶后，将囊肿内袋缝术至腹腔是既定的最终治疗方法。如果将淋巴囊肿的腹膜开窗与大网膜植入相结合，该手术固有的风险和困难可以降低。详细描述的这项技术在14例病例中取得了完全令人满意的结果。
