Vol.5, No 1, 1998 pp. 72 - 74
UDC: 616-06;616-089
DIAGNOSIS AND TREATMENT OF POSTOPERATIVE
LYMPHOCELE IN RENAL TRANSPLANTATION
Z. Džamić, J. Hadži-Djokić, D. Milutinović, Z. Borić, C. Tulić,
N. Lalić, M. Aćimović
Clinic of Urology, Institute of Urology and Nephrology, Clinical Center
of Serbia, Belgrade, Yugoslavia
Summary. As a surgical complication of renal transplantation lymphocele
account for as much as 6-18% complications reported by major referential
series. The most common cause if lymphatic injury in the course of preparation
of the iliac vessels of the recipients, i.e. unligated lymph vessels in
the renal hilus of the donor. Other etiological factors, such as acute
rejection, urinary obstructions or decapsulation of the graft my contribute
to development of this serious complication.
The treatment of large symptomatic lymphocele implies two basic methods:
b) surgical approach with internal drainage and marsupialiyation, and
b) percutaneous puncture and drainage. In our series (311 transplanted
kidneys) the presence of lymphocele necessitating further therapy was recorded
in 6.4% (18). Clinical picture was dominated by renal failure in 47%, stasis
in the excretory system induced by external compression in 41%, and inguinal
edema ion 53%, while scrotal edema, febrile infection, lymphorrhea and
pain were less common (12-24%).
Complete cure of the process with no interventional therapy ensued
in 3 cases (17.6%). Puncture was applied in 29.4% (5 cases), while puncture
with drainage and instillation of povidone iodide was applied in 12 patients
(70.5%). Surgical therapy was applied in 2 patients (11.7%). The eventual
response to the therapeutic procedures was satisfactory.
The results obtained in our series suggest the need for prolonged drainage
with instillation of povidone iodide as a satisfactory method in treatment
of complicated lymphocele.
Key words: Lymphocele, renal transplantation, diagnosis, therapy
DIJAGNOZA I TRETMAN POSTOPERATIVNIH LIMFOCELA
U BUBREŽNOJ TRANSPLATACIJI
Limfocele su kao hirurška komplikacija bubrežne transplantacije odgovorne
za visok procenat komplikacija koje se javljaju u rasponu 6-18% u najvećim
svetskim referentnim serijama i kada se kompariraju sa drugim komplikacijama.
Najčešći uzrok je povreda limfatika u toku postupaka preparacije ilijačnih
sudova recipijenta, odnosno neligirani limfni sudovi u bubrežnom hulusu
kod donora. Drugi etiološki činioci kao akutno odbacivanje, urinarna opstrukcija,
odnosno dekapsulacija grafta mogu doprineti nastanku ove ozbiljne komplikacije.
Tretman velikih simptomatskih limfocela podrazumeva dve osnovne metode:
a) hirurški pristup sa internom drenažom i marsupijalizacijom i
b) perkutana punkcija i drenaža.
Na našem materijalu (311 transplantacija bubrega) prisustvo limfocela
koje su zahtevale sledeći: poremećaj bubrežne funkcije 47%, staza u kanalnom
sistemu prouzrokovana spoljnom kompresijom 41% i ingvinalni edem 53%, dok
je zastupljenost edema skrotuma, infekcije sa povišenom temperaturom, limforeje
i bola bila znatno redja (12-24%).
Kompletna sanacija procesa bez preduzimanja interventne terapije zabeležena
je u 3 slučaja (17.6%). Punkcija je korišćena u 29.4% (5 slučajeva), dok
je punkcija sa drenažom i instalacijom povidon-jodida bila zastupljena
kod 12 pacijenata (70.5%). Hirurški tretman sproveden je kod 2 pacijenta
(11.7%). Konačni odgovor na terapijske procedure bio je zadovoljavajući.
Rezultati dobijeni na našem materijalu, upućuju nas na potrebu prolongirane
drenaže sa instilacijom povidon-jodida, kao na zadovoljavajuću metodu u
tretmanu komplikovanih limfocela.
Ključne reči: Limfocele, bubrežna transplatacija, dijagnoza,
tretman
