Freid R M, Siegel D, Smith A D, Weiss G H
Department of Urology, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA.
Urology. 1998 May;51(5A Suppl):131-4. doi: 10.1016/s0090-4295(98)00074-0.
Lymphocele formation has been infrequently reported as a complication of laparoscopic pelvic lymph node dissection (LPLND). We determined the incidence of clinical and subclinical lymphocele formation in patients undergoing transperitoneal LPLND.
Charts and radiological records of 111 patients undergoing transperitoneal LPLND at this institution between January 1991 and December 1995 were reviewed to determine the incidence of lymphocele formation.
Of 111 patients undergoing LPLND, 12.6% had positive lymph nodes and received hormonal therapy. Radical retropubic (12) or perineal (28) prostatectomy was performed either simultaneously or within 2 weeks in 41% of the node-negative patients. Radiation therapy was the treatment modality in the remaining node negative patients (N = 57). Twenty-three patients undergoing radiation therapy had preplanning pelvic computed tomography (CT) scans 2 to 16 weeks (mean 8.2 weeks) after LPLND. These were reviewed by a single radiologist to determine the presence of subclinical lymphoceles. Seven patients (30.4%) had lymphoceles of varying sizes (3 large and 4 small). Although most were identified on CT scans 4 weeks after the procedure, two were identified on scans 12 and 16 weeks after the procedure (mean 6.5 weeks). None of these patients developed symptoms referable to or had treatment for the lymphocele during a 2 to 37 month follow-up (mean 20 months). Only two patients (3.5%) undergoing LPLND as an isolated procedure had clinical evidence of lymphocele formation, both of which were subsequently confirmed with CT scans (1 large, 1 small). One was treated with CT-guided drainage and sclerosis and the other resolved spontaneously.
The clinical incidence of lymphocele formation following LPLND remains relatively low. Only a portion of these patients requires intervention. Subclinical lymphoceles, as detected on follow-up CT scans, occur with a much greater frequency. These seldom become symptomatic requiring treatment. Rather, they appear to resolve spontaneously. Nevertheless, clinical suspicion should remain high in order to detect and properly treat symptomatic lymphoceles when they occur.
淋巴囊肿形成作为腹腔镜盆腔淋巴结清扫术（LPLND）的一种并发症，鲜有报道。我们确定了接受经腹LPLND患者临床和亚临床淋巴囊肿形成的发生率。
回顾了1991年1月至1995年12月在本机构接受经腹LPLND的111例患者的病历和放射学记录，以确定淋巴囊肿形成的发生率。
在111例接受LPLND的患者中，12.6%有阳性淋巴结并接受了激素治疗。41%的淋巴结阴性患者同时或在2周内接受了根治性耻骨后（12例）或会阴（28例）前列腺切除术。其余淋巴结阴性患者（N = 57）采用放射治疗。23例接受放射治疗的患者在LPLND后2至16周（平均8.2周）进行了盆腔计算机断层扫描（CT）预计划扫描。由一名放射科医生对这些扫描结果进行评估，以确定是否存在亚临床淋巴囊肿。7例患者（30.4%）有大小不一的淋巴囊肿（3个大的和4个小的）。虽然大多数在术后4周的CT扫描中被发现，但有2例在术后12周和16周的扫描中被发现（平均6.5周）。在2至37个月的随访（平均20个月）期间，这些患者均未出现与淋巴囊肿相关的症状或接受治疗。仅2例（3.5%）单独接受LPLND手术的患者有淋巴囊肿形成的临床证据，两者随后均经CT扫描证实（1个大的，1个小的）。1例接受了CT引导下引流和硬化治疗，另1例自行消退。
LPLND后淋巴囊肿形成的临床发生率仍然相对较低。这些患者中只有一部分需要干预。随访CT扫描发现的亚临床淋巴囊肿发生率要高得多。这些囊肿很少出现需要治疗的症状。相反，它们似乎会自行消退。然而，仍应高度怀疑，以便在有症状的淋巴囊肿出现时能够及时发现并进行适当治疗。
