Musch Michael, Klevecka Virgilijus, Roggenbuck Ulla, Kroepfl Darko
Department of Urology, Pediatric Urology and Urologic Oncology, Kliniken Essen-Mitte, Essen, Germany.
J Urol. 2008 Mar;179(3):923-8; discussion 928-9. doi: 10.1016/j.juro.2007.10.072. Epub 2008 Jan 22.
We evaluated the perioperative complications associated with pelvic lymphadenectomy in patients undergoing radical retropubic prostatectomy. In particular the influence of the extent of pelvic lymphadenectomy and of other possible risk factors on the complication rate was examined.
All intraoperative and early postoperative complications in 1,380 patients who underwent radical retropubic prostatectomy were documented. Complications related to pelvic lymphadenectomy were described and evaluated statistically to explore the role of possible risk factors.
Limited pelvic lymphadenectomy was performed in 867 patients and an extended procedure was done in 434. In 60 cases pelvic lymphadenectomy was not specified and in 19 pelvic lymphadenectomy was omitted. Intraoperative complications associated with pelvic lymphadenectomy were rare events (8 cases). Early postoperative complications included hemorrhage of the obturator artery in 1 patient, symptomatic lymphocele in 72, thromboembolic sequelae in 6 and lymphocele infection in 2. Lymphocele formation depended on the extent of pelvic lymphadenectomy (p <0.0001), the number of lymph nodes removed (p = 0.0038) and the operating surgeon (p = 0.0073). Thromboembolic events (p = 0.001) and re-interventions (p <0.0001) were more frequent in patients with a lymphocele. Multivariate analysis confirmed extended pelvic lymphadenectomy as an independent risk factor for lymphocele and re-intervention.
Pelvic lymphadenectomy is the cause of a relevant number of perioperative complications in patients undergoing radical retropubic prostatectomy. Lymphocele formation, and the associated re-interventions and thromboembolic sequelae account for by far the highest percent of these complications. In the current study lymphocele formation depended on the extent of pelvic lymphadenectomy, the number of lymph nodes removed and the operating surgeon.
我们评估了耻骨后根治性前列腺切除术患者盆腔淋巴结清扫术相关的围手术期并发症。特别研究了盆腔淋巴结清扫范围及其他可能的危险因素对并发症发生率的影响。
记录了1380例行耻骨后根治性前列腺切除术患者的所有术中及术后早期并发症。描述并统计评估了与盆腔淋巴结清扫术相关的并发症，以探讨可能危险因素的作用。
867例患者行局限性盆腔淋巴结清扫术，434例患者行扩大性手术。60例未明确盆腔淋巴结清扫情况，19例未行盆腔淋巴结清扫术。与盆腔淋巴结清扫术相关的术中并发症罕见（8例）。术后早期并发症包括1例闭孔动脉出血、72例有症状的淋巴囊肿、6例血栓栓塞后遗症和2例淋巴囊肿感染。淋巴囊肿形成取决于盆腔淋巴结清扫范围（p<0.0001）、切除淋巴结数量（p = 0.0038）及手术医生（p = 0.0073）。有淋巴囊肿的患者血栓栓塞事件（p = 0.001）和再次干预（p<0.0001）更常见。多因素分析证实扩大性盆腔淋巴结清扫术是淋巴囊肿和再次干预的独立危险因素。
盆腔淋巴结清扫术是耻骨后根治性前列腺切除术患者围手术期相当一部分并发症的原因。淋巴囊肿形成以及相关的再次干预和血栓栓塞后遗症在这些并发症中占比最高。在本研究中，淋巴囊肿形成取决于盆腔淋巴结清扫范围、切除淋巴结数量及手术医生。
