Department of Urology, Muljibhai Patel Urological Hospital, Virendra desai Marg, Nadiad, Gujarat, 387001, India.
World J Urol. 2017 Sep;35(9):1443-1450. doi: 10.1007/s00345-016-1997-x. Epub 2017 Jan 30.
Lymphyocele by definition is the collection of lymph that is contained by a pseudomembrane. Management of lymphocele varies from simple aspiration or aspiration with sclerothreapy to more invasive technique, such as internal/external drainage. We present the results of 36 patients who developed pelvic lymphocele after renal transplant.
A total of 1720 patients underwent living related donor renal allograft transplant at our centre. Of the total 1720 transplants 36 patients developed symptomatic lymphocele and underwent definitive management. Retrospectively analysis of the clinical data of these 36 patients was done.
Thrirt six patients (2.09%) had a clinically significant lymphocele, which needed definitive management. All these patients underwent ultrasound guided drain placement and sclerosant injection. Fifteen out of 36 patients (41.6%) had successful treament with percutaneous drain placement. Laparoscopic marsupialization of lymphocele was done in 21 patients who failed percutaneous drain insertion therapy after diagnostic aspiration. Laparoscopic Marsupilization was successful in 18 out of 21 patients (85.7%). The 3 patients with failed laparoscopic marsupialization were managed with open surgical marsupialization.
Significant number of lymphocele post renal transplant may be asymptomatic but still cause deterioration of renal function even without causing obstructive uropathy. Lymphoceles causing renal deterioration or symptoms should be managed in a step ladder fashion starting from percutaneous drainage to laparoscopic marsupilization to open surgical approach. Asymptomatic recurrences post marsupialization are common and should be only closely observed unless they become symptomatic or cause deterioration of renal function. A systematic protocol may help in treating these patients better.
淋巴囊肿的定义是淋巴被假膜包裹而形成的积液。淋巴囊肿的处理方法各不相同，从简单的抽吸或抽吸加硬化治疗到更具侵袭性的技术，如内/外引流。我们报告了 36 例肾移植后发生盆腔淋巴囊肿的患者的结果。
我们中心共对 1720 例活体亲属供肾移植患者进行了研究。在这 1720 例移植中，有 36 例患者出现症状性淋巴囊肿并接受了确定性治疗。对这 36 例患者的临床资料进行回顾性分析。
36 例患者（2.09%）发生有临床意义的淋巴囊肿，需要进行确定性治疗。所有这些患者均接受了超声引导下引流管放置和硬化剂注射。在 36 例患者中，有 15 例（41.6%）经皮引流成功。对于经诊断性抽吸后经皮引流治疗失败的 21 例患者，进行了腹腔镜淋巴囊肿造口术。在 21 例患者中，腹腔镜造口术成功 18 例（85.7%）。3 例腹腔镜造口术失败的患者采用开放手术造口术治疗。
肾移植后大量的淋巴囊肿可能是无症状的，但即使不引起尿路梗阻，仍会导致肾功能恶化。引起肾功能恶化或症状的淋巴囊肿应采用阶梯式治疗方法，从经皮引流开始，到腹腔镜淋巴囊肿造口术，再到开放手术。造口术后无症状复发很常见，应密切观察，除非出现症状或导致肾功能恶化。一个系统的方案可能有助于更好地治疗这些患者。
