Ahmed Shyaw, Shaw Greg, AlKadhi Omar
Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
J Endourol Case Rep. 2019 Dec 2;5(4):139-141. doi: 10.1089/cren.2018.0080. eCollection 2019.
Lymph leakage is regarded as one of the rare complications of major abdominal, pelvic, and thoracic surgeries. Lymphangiogram seems to be the principal diagnostic modality. Management strategies that have been shown in the literature range from conservative measures to surgical exploration. However, the rarity and diversity in the presentation of this complication have attributed to the lack of consensus and guideline on its management. A 49-year-old obese man with prostate-specific antigen of 10 and preoperative Gleason score of 8 prostate cancer and initial staging of TNM has undergone robot-assisted radical prostatectomy and extended pelvic lymph node dissection with unilateral nerve sparing. Our patient was admitted with significant ascites on day 14 postoperative, which was confirmed on CT abdomen and initially managed with nutritional support and percutaneous drainage. A lipidiol lymphangiogram demonstrated lymphatic leakage near the right external iliac vein. While he was awaiting elective surgical exploration, he has had two further successive admissions with massive ascites, anemia and raised C-reactive protein with acute kidney injury. A laparoscopic exploration was performed with interventional radiology assistance to direct dissection to the site of leak. An abscess cavity was found and excised. The lymphatic leak tailed off to insignificance rapidly thereafter. Each case of lymphatic leakage seems to require an individualized approach according to the nature and severity of the lymphatic leak and patient condition. Although it is possible that the collection was infected lymphatic fluid, the position of the abscess cavity in proximity to the site where the lipidiol was seen to leak from the lymphatics suggests that it is possible that the lipidiol was the nidus for infection. Either way what is interesting is that the presence of the abscess caused prolonged and profuse lymphatic leakage.
淋巴漏被视为腹部、盆腔和胸部大型手术罕见的并发症之一。淋巴管造影似乎是主要的诊断方式。文献中显示的管理策略从保守措施到手术探查不等。然而，这种并发症表现的罕见性和多样性导致在其管理方面缺乏共识和指南。一名49岁的肥胖男性，前列腺特异性抗原为10，术前Gleason评分为8分，前列腺癌，TNM初始分期，接受了机器人辅助根治性前列腺切除术和单侧保留神经的扩大盆腔淋巴结清扫术。我们的患者在术后第14天因大量腹水入院，腹部CT证实了这一点，最初采用营养支持和经皮引流进行处理。脂质碘油淋巴管造影显示右髂外静脉附近存在淋巴漏。在他等待择期手术探查期间，又因大量腹水、贫血、C反应蛋白升高伴急性肾损伤先后两次入院。在介入放射学辅助下进行了腹腔镜探查，以直接解剖至漏出部位。发现并切除了一个脓肿腔。此后淋巴漏迅速减少至微不足道。每例淋巴漏似乎都需要根据淋巴漏的性质和严重程度以及患者状况采取个体化方法。虽然积液可能是感染的淋巴液，但脓肿腔位于脂质碘油从淋巴管漏出部位附近，这表明脂质碘油可能是感染的病灶。不管怎样，有趣的是脓肿的存在导致了长时间大量的淋巴漏。
