Department of Urology and Kidney Transplantation, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France.
Department of Radiology, Aix-Marseille University, APHM, Conception Academic Hospital, Marseille, France.
Int Urol Nephrol. 2021 Apr;53(4):685-690. doi: 10.1007/s11255-020-02709-2. Epub 2020 Nov 10.
To report the efficacy and safety of povidone-iodine sclerotherapy of primary symptomatic lymphocele after kidney transplantation in a large contemporary cohort study.
A single-institutional study was conducted including consecutive patients who underwent povidone-iodine sclerotherapy for primary symptomatic lymphocele after kidney transplantation between January 2013 and March 2020. Sclerotherapy was used as the first-line treatment of symptomatic lymphocele. Recurrent lymphoceles were managed with open or laparoscopic fenestration. The primary outcome was the efficacy of sclerotherapy which was defined as the absence of second sclerotherapy or salvage surgery.
A total of 965 renal transplantations were included. Sclerotherapy for primary symptomatic lymphocele was performed in 60 cases (6.2%). The median (IQR) number of instillation, the volume of povidone-iodine per instillation and drainage time were 3 (3-3), 60 (38-80) mL and 6 days (5-8), respectively. Sclerotherapy related complications were reported in eight cases (13.3%) and included five cases of accidental catheter removal, two cases of lumbosciatica, and one case of intraperitoneal diffusion of povidone-iodine. After a median (IQR) follow-up of 33 (14-60) months, treatment success was achieved in 33 cases (55%). Multivariate analysis failed to identify predictors of sclerotherapy failure. Salvage therapies included 7 s sclerotherapy and 20 surgical fenestrations with an overall success rate of 88.8% (24/27).
Sclerotherapy was an easy and safe procedure to treat primary symptomatic lymphocele in renal transplant recipients. Despite moderate efficacy, recurrences were easily controlled with salvage therapies. Further studies are necessary to identify predictive factors of sclerotherapy failure to directly refer patients to surgical treatment.
在一项大型当代队列研究中报告聚维酮碘硬化疗法治疗肾移植后原发性症状性淋巴囊肿的疗效和安全性。
进行了一项单中心研究，纳入了 2013 年 1 月至 2020 年 3 月期间因肾移植后原发性症状性淋巴囊肿而行聚维酮碘硬化治疗的连续患者。硬化疗法被用作症状性淋巴囊肿的一线治疗方法。复发性淋巴囊肿采用开放或腹腔镜开窗术治疗。主要结局是硬化治疗的疗效，定义为无需再次硬化治疗或挽救性手术。
共纳入 965 例肾移植患者。60 例（6.2%）患者行原发性症状性淋巴囊肿硬化治疗。腔内注射次数、每次注射的聚维酮碘体积和引流时间的中位数（IQR）分别为 3（3-3）次、60（38-80）mL 和 6 天（5-8 天）。8 例（13.3%）发生与硬化治疗相关的并发症，包括 5 例导管意外脱落、2 例腰背部疼痛和 1 例聚维酮碘腹腔内扩散。中位（IQR）随访 33（14-60）个月后，33 例（55%）患者治疗成功。多因素分析未能确定硬化治疗失败的预测因素。挽救性治疗包括 7 例再次硬化治疗和 20 例手术开窗，总体成功率为 88.8%（24/27）。
硬化治疗是治疗肾移植受者原发性症状性淋巴囊肿的一种简便、安全的方法。尽管疗效中等，但复发后很容易通过挽救性治疗得到控制。需要进一步的研究来确定硬化治疗失败的预测因素，以便直接将患者转至手术治疗。
