Diagnostic and Interventional Radiology, Klinik Dr. Hancken GmbH, Stade, Germany.
Diagnostic and Interventional Radiology, Mühlenkreiskliniken, Minden, Germany.
Rofo. 2022 Apr;194(4):384-390. doi: 10.1055/a-1586-3652. Epub 2021 Oct 14.
Lymphoceles often occur within several weeks or even months after surgery. Mostly asymptomatic and therefore undiagnosed, they may be self-healing without any treatment. A small percentage of postoperative lymphoceles are symptomatic with significant pain, infection, or compression of vital structures, thus requiring intervention. Many different treatment options are described in the literature, like drainage with or without sclerotherapy, embolization of lymph vessels, and surgical approaches with laparoscopy or laparotomy. Inspired by reports stating that postoperative suction drainage can prevent the formation of lymphoceles, we developed a simple protocol for vacuum-assisted drainage of symptomatic lymphoceles, which proved to be successful and which we would therefore like to present.
Between 2008 and 2020, 35 patients with symptomatic postoperative lymphoceles were treated with vacuum-assisted suction drainage (in total 39 lymphoceles). The surgery that caused lymphocele formation had been performed between 8 and 572 days before. All lymphoceles were diagnosed based on biochemical and cytologic findings in aspirated fluid. The clinical and imaging data were collected and retrospectively analyzed.
In total, 43 suction drainage catheters were inserted under CT guidance. The technical success rate was 100 %. One patient died of severe preexisting pulmonary embolism, sepsis, and poor conditions (non-procedure-related death). In 94.8 % of symptomatic lymphoceles, healing and total disappearance could be achieved. 4 lymphoceles had a relapse or dislocation of the drainage catheter and needed a second drainage procedure. Two lymphoceles needed further surgery. The complication rate of the procedure was 4.6 % (2/43, minor complications). The median indwelling time of a suction drainage catheter was 8-9 days (range: 1-30 days).
The positive effects of negative pressure therapy in local wound therapy have been investigated for a long time. These positive effects also seem to have an impact on suction drainage of symptomatic lymphoceles with a high cure rate.
· Suction drainage of lymphoceles is an easy and successful method to cure symptomatic lymphoceles at various locations.. · We believe this to be due to the induction of cavity collapse and surface adherence.. · In most cases rapid clinical improvement could be obtained..
· Franke M, Saager C, Kröger J et al. Vacuum-Assisted Suction Drainage as a Successful Treatment Option for Postoperative Symptomatic Lymphoceles. Fortschr Röntgenstr 2022; 194: 384 - 390.
术后数周甚至数月常发生淋巴囊肿。大多数无症状，因此未被诊断，可能无需治疗即可自行愈合。一小部分术后淋巴囊肿出现显著疼痛、感染或重要结构受压等症状，需要治疗。文献中描述了许多不同的治疗方法，如引流伴或不伴硬化治疗、淋巴管栓塞和腹腔镜或剖腹手术。受术后负压引流可预防淋巴囊肿形成的报道启发，我们开发了一种针对症状性淋巴囊肿的简单负压引流方案，该方案已被证明是成功的，因此我们将进行介绍。
2008 年至 2020 年，35 例因手术导致的症状性术后淋巴囊肿患者接受了真空辅助抽吸引流（共 39 个淋巴囊肿）。导致淋巴囊肿形成的手术发生在 8 至 572 天前。所有淋巴囊肿均根据抽吸液的生化和细胞学发现进行诊断。收集并回顾性分析了临床和影像学数据。
共在 CT 引导下插入 43 根引流导管。技术成功率为 100%。1 例患者因严重的预先存在的肺栓塞、败血症和条件差（与手术无关的死亡）死亡。94.8%的症状性淋巴囊肿可治愈和完全消失。4 个淋巴囊肿引流导管出现复发或脱位，需要再次引流。2 个淋巴囊肿需要进一步手术。该操作的并发症发生率为 4.6%（2/43，轻微并发症）。引流导管的中位留置时间为 8-9 天（范围：1-30 天）。
负压治疗在局部伤口治疗中的积极作用已被研究了很长时间。这些积极作用似乎也对各种部位症状性淋巴囊肿的引流有影响，治愈率高。
· 淋巴囊肿抽吸引流是治疗各种部位症状性淋巴囊肿的一种简单而成功的方法。
· 我们认为这是由于诱导腔塌陷和表面附着所致。
· 在大多数情况下，可以迅速改善临床症状。
