Le Roux Y, Bottet P, Brefort J L, Dornier L, Hurault de Ligny B, Samama G
Service de Chirurgie générale, viscérale et digestive, CHU Côte de Nacre, Caen.
Presse Med. 1994 Feb 12;23(6):288-90.
The appropriate treatment for symptomatic pelvic lymphoceles occurring after renal transplantation is still debated. External drainage exposes to risk of recurrence, infection or graft sclerosis and laparotomy has been required for intraperitoneal marsupialization in patients at risk. We report our experience with two cases treated by laparoscopic intraperitoneal marsupialization.
From November 1986 to September 1992, 170 renal transplantations were performed at our University Hospital. Lymphoceles developed in 12 cases and percutaneous puncture and irrigation was performed in all, successfully in 10. Relapse occurred in 2 patients--one 50-year-old woman with chronic glomerulonephritis and one 41-year-old man on peritoneal dialysis for polycystic renal disease--recipients of cadaver kidneys.
The laparoscopy was conducted under general anaesthesia. Four trocars were inserted, a 10 mm via the umbilicus for the optical system and three 5 mm trocars via the right and left flank and the left iliac fossa. A long puncture needle was used to drain the lymphocele and a localized collection and a large peritoneal window was created. The abdominal cavity was abundantly washed before withdrawing.
Operation time was 35 minutes and conversion to laparotomy was not required. The only complication was a haematoma at one insertion site. Patients were discharged on day 2 and on day 1 with an unchanged immunosuppressor regimen. At 10 months follow-up, the patients were symptom-free and echography was normal.
Surgical treatment of lymphoceles can be successfully performed by laparoscopy. The choice between conservative treatment and laparoscopic surgery remains to be determined.
肾移植术后有症状的盆腔淋巴囊肿的恰当治疗方法仍存在争议。外部引流有复发、感染或移植肾硬化的风险，对于有风险的患者，剖腹手术已成为腹膜内造袋术所必需的。我们报告了两例经腹腔镜腹膜内造袋术治疗的经验。
1986年11月至1992年9月，我校医院共进行了170例肾移植手术。12例出现淋巴囊肿，均进行了经皮穿刺和冲洗，10例成功。2例复发，分别为1例患有慢性肾小球肾炎的50岁女性和1例因多囊肾病接受尸体肾移植的41岁接受腹膜透析的男性。
在全身麻醉下进行腹腔镜检查。插入四个套管针，一个10毫米的通过脐部用于光学系统，三个5毫米的套管针分别通过左右侧腹和左髂窝插入。使用长穿刺针引流淋巴囊肿，并形成一个局部积液区和一个大的腹膜窗口。在拔出之前，对腹腔进行充分冲洗。
手术时间为35分钟，无需转为剖腹手术。唯一的并发症是一个穿刺部位出现血肿。患者在术后第2天出院，免疫抑制剂方案不变，在术后第1天情况也未改变。在10个月的随访中，患者无症状，超声检查正常。
腹腔镜检查可成功地对淋巴囊肿进行手术治疗。保守治疗和腹腔镜手术之间的选择仍有待确定。
