La Fianza A, Campani R, Dore R, Babilonti L, Tateo S, Calliada F
Istituto di Radiologia, Università degli Studi di Pavia.
Radiol Med. 1993 Jul-Aug;86(1-2):106-15.
The staging of gynecologic cancers requires the knowledge of lymph node status and thus pelvic and/or lumbo-aortic lymphadenectomy remains, to date, a widely used procedure. Lymphoceles are a frequent complication of surgical lymph node dissection. They are lymph collections in the retroperitoneum following the continuous drainage of afferent lymph vessels. To assess the incidence of this complication, its CT features and the role of diagnostic imaging to treat lymphoceles, 140 patients were retrospectively evaluated. Forty of them had undergone pelvic and/or lumbo-aortic lymphadenectomy for proved endometrial carcinoma, 51/140 for proved carcinoma of the cervix uteri, and 49/140 for proved malignant epithelial cancer in the ovary. CT exams were performed during the follow-up, not on a systematic basis but only when a recurrence was clinically suspected (117 cases), or in the presence of surgery and/or irradiation complications (11 cases), or to assess the extent of residual lesion during chemo/radiotherapy (12 cases). Fifty-three lymphoceles were observed in 36 patients: they were monolateral in 18 cases and bilateral in 16; in 34 cases the lymphoceles were found in the iliac space and in 3 cases only in the median perivascular lumbo-aortic space. In the patients with clinically suspected recurrence (117 patients, 27 lymphoceles), lymphoceles were associated with the recurrence in 25 cases, while they were the only CT evidence of a mass in 2 patients. In the cases with clinically suspected complications of former irradiation and surgery (11 patients, 3 lymphoceles), lymphoceles were correctly differentiated from abscesses (2 cases), seroceles (1 case), and hematomas (2 cases). In the group of asymptomatic patients monitored for residual disease (12 patients, 5 lymphoceles), lymphoceles were an occasional finding and, since they caused no complications to the urinary and GI tracts, they were never treated. Four asymptomatic patients only, with no evidence of disease, were submitted to transcutaneous aspiration and drainage under CT-US guidance (1.7 procedures per patient), and lymphoceles resolved in 3/4 cases. The only lymphocele recurring more than once required another laparotomy. In our experience, lymphoceles appear as a common sequela of pelvic lymphadenectomy for gynecologic cancer. CT has proved to be a useful diagnostic tool to assess and characterize the lesions, which must be differentiated from other postoperative complications and from recurring tumors. Lymphoceles needed to treatment in most cases and thus only symptomatic patients, with no cancer, were submitted to aspiration and drainage under CT-US guidance; the maneuver was successful on 75% of cases.
妇科癌症的分期需要了解淋巴结状态，因此盆腔和/或腰主动脉淋巴结切除术至今仍是一种广泛应用的手术。淋巴管囊肿是手术淋巴结清扫的常见并发症。它们是传入淋巴管持续引流后腹膜后的淋巴液聚集。为了评估这种并发症的发生率、其CT特征以及诊断性影像学在治疗淋巴管囊肿中的作用，我们对140例患者进行了回顾性评估。其中40例因确诊子宫内膜癌接受了盆腔和/或腰主动脉淋巴结切除术，140例中有51例因确诊子宫颈癌接受了该手术，140例中有49例因确诊卵巢恶性上皮癌接受了该手术。CT检查在随访期间进行，并非系统进行，仅在临床怀疑复发时（117例）、存在手术和/或放疗并发症时（11例）或评估放化疗期间残余病变范围时（12例）进行。在36例患者中观察到53个淋巴管囊肿：18例为单侧，16例为双侧；34例淋巴管囊肿位于髂窝，3例仅位于腰主动脉血管周围的中位间隙。在临床怀疑复发的患者中（117例患者，27个淋巴管囊肿），25例淋巴管囊肿与复发相关，而2例患者中淋巴管囊肿是肿块的唯一CT证据。在临床怀疑既往放疗和手术并发症的病例中（11例患者，3个淋巴管囊肿），淋巴管囊肿与脓肿（2例）、血清囊肿（1例）和血肿（2例）得到了正确区分。在监测残余疾病的无症状患者组中（12例患者，5个淋巴管囊肿），淋巴管囊肿是偶然发现，由于它们未对泌尿系统和胃肠道造成并发症，因此从未进行治疗。仅4例无症状患者，无疾病证据，在CT-US引导下接受了经皮抽吸和引流（每位患者1.7次操作），4例中有3例淋巴管囊肿消退。唯一复发不止一次的淋巴管囊肿需要再次剖腹手术。根据我们的经验，淋巴管囊肿似乎是妇科癌症盆腔淋巴结清扫术后的常见后遗症。CT已被证明是评估和表征病变的有用诊断工具，这些病变必须与其他术后并发症和复发性肿瘤区分开来。大多数情况下淋巴管囊肿需要治疗，因此仅对无癌症的有症状患者在CT-US引导下进行抽吸和引流；该操作在75%的病例中成功。
