Department of Vascular and Transplant Surgery, Radboudumc, Postbus 9101, 6500 HB, Nijmegen, The Netherlands.
Department of Urology, Radboudumc, Nijmegen, The Netherlands.
Int Urol Nephrol. 2019 Dec;51(12):2161-2167. doi: 10.1007/s11255-019-02269-0. Epub 2019 Sep 5.
The development of a symptomatic lymphocele (SL) is a frequent postoperative surgical complication after kidney transplantation. It may lead to pain and discomfort and cause transplant malfunction or even secondary graft loss. A large cohort of renal recipients was investigated to identify the possible risk factors for SL.
All renal transplant patients of a single centre were retrospectively analysed for SL between January 2010 and December 2017. The SL group was compared to a control group from the same cohort.
45 out of 1003 transplanted patients developed an SL (incidence 4.5%), on average 50 days after kidney transplantation. SLs developed more in older patients, in those with a PD catheter and in ADKDP as primary diagnosis. Surgical predictors for SLs were venous anastomosis on the external iliac vein, concomitant PD catheter removal, perfusion defects, shorter operating time, splint > 7 days, double J stenting, discharge with drain, low initial drain production and ureteral obstruction. Opening of the peritoneum, re-operation for postoperative bleeding and previous nephrectomy seem protective for developing SL.
We found multiple heterogeneous predictors for SL with a common denominator related to surgical management of the retroperitoneal space, peritoneum and the ureter. Future prospective studies are necessary to evaluate the influence of these variables on the development of SL.
症状性淋巴囊肿（symptomatic lymphocele，SL）是肾移植术后常见的手术并发症。它可能导致疼痛和不适，并导致移植器官功能障碍，甚至继发性移植物丢失。本研究调查了大量肾移植受者，以确定 SL 的可能危险因素。
回顾性分析 2010 年 1 月至 2017 年 12 月期间，单一中心的所有肾移植患者的 SL 情况。将 SL 组与同一队列中的对照组进行比较。
1003 例移植患者中有 45 例（发生率 4.5%）出现 SL，平均在肾移植后 50 天。SL 更常见于老年患者、PD 导管患者和 ADKDP 作为主要诊断的患者。SL 的手术预测因素包括髂外静脉外吻合、同时拔除 PD 导管、灌注缺陷、手术时间较短、夹板>7 天、双 J 支架置入、带引流管出院、初始引流产量低和输尿管梗阻。打开腹膜、因术后出血再次手术和先前的肾切除术似乎对 SL 的发生有保护作用。
我们发现了多个与腹膜后空间、腹膜和输尿管的手术处理相关的 SL 异质预测因素。未来有必要进行前瞻性研究，以评估这些变量对 SL 发展的影响。
