肾移植术后伤口淋巴漏和淋巴囊肿分析

Analysis of percutaneous lymphorrhagia and lymphoceles after renal transplantation

目的 :探讨尸肾移植术后发生伤口淋巴漏和髂窝淋巴囊肿的原因及其防治方法。方法 :统计 489例尸肾移植患者 ,对其中发生术后长时间伤口淋巴漏或症状性髂窝淋巴囊肿的患者进行回顾性分析。结果 :尸肾移植术后发生长时间伤口淋巴漏 8例 ,症状性髂窝淋巴囊肿 7例。治疗方法包括体外引流、硬化剂治疗及腹腔内引流术等。结论 :肾移植手术应防止操作粗暴 ,以减少受者淋巴管的损伤和移植肾淋巴液漏出 ;对术后长时间伤口淋巴漏和出现症状的髂窝淋巴囊肿 。

Purpose:To investigate the causes and prophylaxis of the percutaneous lymphorrhagia and iliac fossa lymphocele after cadaver renal transplantation. Method:In 489 renal transplant recipients in this study, the recipients with enduring percutaneous lymphorrhagia or symptomatic lymphoceles at iliac fossa after the operations were analysed retrospectively. Result:Among 489 cases of cadaveric renal transplantation, enduring percutaneous lymphorrhagia were seen in 8 recipients, and symptomatic lymphoceles at iliac fossae were found in 7 recipients. The following factors did not influence the occurring probability of enduring percutaneous lymphorrhagia and symptomatic lymphoceles at iliac fossae: sex, the method of dialysis, the method of artery anastomosis, the position of transplanted kidney at left or right iliac fossae and acute rejection. The therapies for enduring percutaneous lymphorrhagia and symptomatic lymphoceles at iliac fossae included percutaneous drainage, sclerotherapy and internal drainage procedures with either marsupialization in the peritoneal cavity or the tubular placement between the peritoneal cavity and the lymphocele. Conclusion:To reduce the occurrence of percutaneous lymphorrhagia or iliac fossa lymphoceles after the renal transplantation, careful surgical techniques should be recommended to avoid damaging lymphatics of the patient and to decrease the lymph leak from the transplanted kidney. The enduring percutaneous lymphorrhagia or symptomatic lymphoceles should be treated actively.