Weckermann D
Urologische Klinik, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland,
Urologe A. 2014 Jul;53(7):996-1000. doi: 10.1007/s00120-014-3480-x.
Extended pelvic lymph node dissection allows exact lymph node staging and has the potential to improve prognosis. In addition to these advantages, there are some perioperative and postoperative complications. In case of transection of the obturator nerve, a microsurgical end-to-end anastomosis should be performed. The most frequent postoperative complication is (symptomatic) lymphocele which is predominantly diagnosed after extraperitoneal surgery. Meticulous lymph node dissection with clipping of lymphatic vessels, sparing the lateral wall of the external iliac artery from dissection, sufficient postoperative drainage, and application of low molecular weight heparin in the upper arm may reduce their incidence. Instillation of sclerosing agents and sufficient drainage are normally successful. If not, laparoscopic fenestration of lymphocele should be performed. Regular ultrasound examinations are necessary to diagnose and treat postoperative lymphocele in a timely manner.
扩大盆腔淋巴结清扫术可实现准确的淋巴结分期，并有改善预后的潜力。除了这些优势外，还存在一些围手术期和术后并发症。若闭孔神经被切断，应进行显微外科端端吻合术。最常见的术后并发症是（有症状的）淋巴囊肿，主要在腹膜外手术后被诊断出来。细致的淋巴结清扫、淋巴管夹闭、避免髂外动脉侧壁清扫、充分的术后引流以及在上臂应用低分子量肝素可能会降低其发生率。硬化剂灌注和充分引流通常是成功的。若不成功，则应进行腹腔镜下淋巴囊肿开窗术。定期超声检查对于及时诊断和治疗术后淋巴囊肿是必要的。
