Goßler Christopher, Hillinger Johannes, Burger Maximilian, Bründl Johannes, Denzinger Stefan, Gierth Michael, Breyer Johannes
Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany.
Transl Androl Urol. 2021 Feb;10(2):821-829. doi: 10.21037/tau-20-1315.
Lymphoceles are a common postoperative complication after radical prostatectomy with pelvic lymphadenectomy. Therapeutic options include cannulation and drainage (CD), drainage and instillation (DI), or laparoscopic fenestration (LF). The aim of this study was to investigate the epidemiology of symptomatic lymphoceles (SLC) and evaluate the treatment options.
We retrospectively analysed all patients who underwent robot-assisted radical prostatectomy (RARP) at our clinic from January 1, 2014 to December 31, 2018. All documented lymphoceles of these patients were recorded and analysed with regard to symptoms, possible infection and the treatment option (or options) chosen.
We were able to include all 1,029 patients who underwent RARP in the aforementioned period of time. Of these, 18.1% were diagnosed with a lymphocele either when discharged or when readmitted and 6.9% experienced an SLC requiring treatment. Thirteen-point-seven percent of patients readmitted with SLC showed an accompanying thrombosis. Due to recurring or bilateral SLCs receiving different treatment options for each side, there was a total of 115 SLCs treated. CD was carried out in 102 cases. Twenty-point-six percent of patients were sufficiently treated this way, the rest required further treatment or experienced recurrences not requiring further treatment. DI was carried out in 56 cases. Of those patients, 46.4% were sufficiently treated. LF was carried out in 54 cases (either after CD, or after DI, or primarily). Of those patients, 98.1% were treated sufficiently. LF had a statistically significant higher success rate compared to CD and DI (P<0.001 respectively).
The study confirmed the significance of SLC as a common complication after RARP. LF turned out to be the most effective treatment option for SLC, while CD as well as DI have not been proven effective.
淋巴管囊肿是根治性前列腺切除术加盆腔淋巴结清扫术后常见的术后并发症。治疗选择包括插管引流（CD）、引流加灌注（DI）或腹腔镜开窗术（LF）。本研究的目的是调查有症状淋巴管囊肿（SLC）的流行病学情况并评估治疗选择。
我们回顾性分析了2014年1月1日至2018年12月31日在我院接受机器人辅助根治性前列腺切除术（RARP）的所有患者。记录并分析这些患者所有记录在案的淋巴管囊肿的症状、可能的感染情况以及所选择的治疗方案。
我们纳入了上述时间段内接受RARP的所有1029例患者。其中，18.1%在出院时或再次入院时被诊断为淋巴管囊肿，6.9%经历了需要治疗的SLC。因SLC再次入院的患者中有13.7%伴有血栓形成。由于复发性或双侧SLC的两侧接受了不同的治疗方案，总共治疗了115例SLC。102例进行了CD。20.6%的患者通过这种方式得到充分治疗，其余患者需要进一步治疗或经历了无需进一步治疗的复发。56例进行了DI。在这些患者中，46.4%得到充分治疗。54例进行了LF（要么在CD之后，要么在DI之后，要么作为首选）。在这些患者中，98.1%得到充分治疗。与CD和DI相比，LF的成功率在统计学上显著更高（P分别<0.001）。
该研究证实了SLC作为RARP术后常见并发症的重要性。结果表明，LF是治疗SLC最有效的选择，而CD和DI尚未被证明有效。
