Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/11 04:36:57」(JST)

wiki en

A lymphocele is a collection of lymphatic fluid within the body not bordered by epithelial lining.^[1] It is usually a surgical complication seen after extensive pelvic surgery (such as cancer surgery) and is most commonly found in the retroperitoneal space. Spontaneous development is rare.^[2]

Etiology[edit]

As already noted by Mori in 1955, the risk of the development of a lymphocele is positively correlated to the extent of the removal of lymphatic tissue during surgery (lymphadenectomy).^[3] Surgery destroys and disrupts the normal channels of lymph flow. If the injury is minor, collateral channels will transport lymph fluid, but with extensive damage, fluid may accumulate in an anatomic space resulting in a lymphocele.^[4] Typical operations leading to lymphocysts are renal transplantation and radical pelvic surgery with lymph node removal because of prostatic or gynecologic cancer.^[5] Other factors that may predispose of lymphocele development are preoperative radiation therapy, heparin prophylaxis (used to prevent deep vein thrombosis), and tumor characteristics.^[1] After radical surgery for cervical and ovarian cancer studies with follow-up CT found lymphoceles in 20% and 32% , respectively.^[6] Typically they develop within 4 months after surgery.^[7]

Symptoms[edit]

Many lymphoceles are asymptomatic. Larger lymphoceles may cause symptoms related to compression of adjacent structures leading to lower abdominal pain, abdominal fullness, constipation, urinary frequency, and edema of the genitals and/or legs. Serious sequelae could develop and include infection of the lymphocele, obstruction and infection of the urinary tract, intestinal obstruction, venous thrombosis, pulmonary embolism, chylous ascites and lymphatic fistula formation.^[1] On clinical examination the skin may be reddened and swollen and a mass felt. Ultrasonography or CT scan will help to establish a diagnosis. Other fluid collections to be considered in the differential diagnosis are urinoma, seroma, hematoma, as well as collections of pus. Also, when lower limb edema is present, venous thrombosis needs to be considered. ^[8] This is called Lymphocele.

Management[edit]

It has been suggested that suction drains placed during surgery and non-peritonisation (not closing the posterior peritoneum) may reduce the possibility of lymphocele development. Smaller lymphoceles can be managed expectantly, and many lesions will regress over time.^[2] For symptomatic lesions a number of approaches are available and include fine needle aspiration with US or CT guidance, catheter insertion and drainage (with possible use of sclerosants), and surgical drainage.^[2]^[5]

References[edit]

^ ^a ^b ^c Metcalf KS, Peel KR. "Lymphocele". Ann R Coll Surg Engl 1993; 75:387-392.
^ ^a ^b ^c de Oliveira Goes Junior AM, Haber Jeha SA (2012). "Idiopathic Lymphocele: A possible Diagnosis for Infraclavicular Masses". Case Reports in Surgery 2012 2012: 1. doi:10.1155/2012/593028.
^ Mori N. "Clinical and experimental studies on so called lymphocyst which develops after radical hysterectomy in cancer of the uterine cervix". J Jpn Obstet Gynecol Soc 1955;2:178.
^ White M, Mueller PR, Ferrucci JT, et al. "Percutaneous drainage of postoperative abdominal and pelvic lymphoceles". Ajr1985; 145:1065-1069.
^ ^a ^b Kim JK, Jeong YY, Kim YH, Kim YC, Kang HK, Choi HS. "Postoperative Pelvic Lymphocele: Treatment with Simple Percutaneous Catheter Drainage". Radiology 1999; 212:390-94.
^ Petru E, Tamussino K, Lahousen M, Winter R, Pickel H, Haas J. "Pelvic and paraaortic lymphocysts after radical surgery because of cervical and ovarian cancer". Am J Obstet Gynecol 1989; 161:937-41.
^ Cantrell CJ, Wilkinson EJ. "Recurrent squamous cell carcinoma of the cervix within pelvic-abdominal lymphocysts". Obstet Gynecol 1983; 62:530-4.
^ McCullough CS, Soper NJ. "Laparoscopic drainage of a post transplant lymphocele". Transplantation 191;51:725-7.

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 婦人科癌における骨盤内および大動脈傍リンパ節郭清 pelvic and paraaortic lymphadenectomy in gynecologic cancers
2. 下肢静脈アブレーションのための開放手術法 open surgical techniques for lower extremity vein ablation
3. 腎臓の同種移植片機能不全の鑑別診断 differential diagnosis of renal allograft dysfunction
4. 椎骨動脈血行再建術 vertebral artery revascularization
5. 尿路閉塞および水腎症の臨床症状および診断 clinical manifestations and diagnosis of urinary tract obstruction and hydronephrosis

English Journal

Wound morbidity after kidney transplant.

Fockens MM1, Alberts VP1, Bemelman FJ2, van der Pant KA2, Idu MM1.
Progress in transplantation (Aliso Viejo, Calif.).Prog Transplant.2015 Mar;25(1):45-8. doi: 10.7182/pit2015812.
Context-Wound morbidity is an important surgical complication after kidney transplant.Objective-To assess risk factors for postoperative wound complications and the impact of such complications on outcomes of kidney transplant.Design and Patients-Retrospectively, 108 consecutive kidney transplant pa
PMID 25758800

The use of tenckhoff catheters for draining of symptomatic lymphoceles: a review of literature and our experience.

Kostro JZ1, Zadrożny D2, Dębska-Ślizień A3, Hellmann A2, Wiśniewski P2, Marek I4, Ławiński M5, Śledziński Z2.
Transplantation proceedings.Transplant Proc.2015 Mar;47(2):384-7. doi: 10.1016/j.transproceed.2014.12.024.
BACKGROUND: Lymphoceles are one of the common complications of kidney transplantations. While small, asymptomatic lypmhoceles do not require intervention, however, larger, high-pressure cases can lead to graft dysfunction and are thus an indication for decompression. The aim of this study is to pres
PMID 25769578

A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer.

Zikan M1, Fischerova D2, Pinkavova I2, Slama J2, Weinberger V3, Dusek L4, Cibula D2.
Gynecologic oncology.Gynecol Oncol.2015 Feb 24. pii: S0090-8258(15)00656-3. doi: 10.1016/j.ygyno.2015.02.016. [Epub ahead of print]
OBJECTIVE: To identify the incidence of asymptomatic and symptomatic (i.e., causing pain, hydronephrosis, venous thrombosis, acute lymphedema of the lower or urinary urgency) lymphoceles, as well as risk factors for their development, through a prospective study of patients undergoing sole pelvic or
PMID 25720294

Japanese Journal

持続ドレナージ法による骨盤内リンパ節郭清後感染性リンパ囊胞の管理について

中村名律子,碓井宏和,三橋暁 [他]
関東連合産科婦人科学会誌 50(1), 19-24, 2013
NAID 40019770815

鼠径部の難治性リンパ漏に対し大網充填併用腹膜開窓術が有効であった2例

渋谷卓,江戸川誠司,佐藤尚司
静脈学 23(1), 51-55, 2012-02-25
… He presented with an intractable groin lymphocele. … Case 2 was a 77-year-old man who underwent an open biopsy of a groin lymph node and presented with an intractable groin lymphocele. … Omentopexy with a peritoneal window is an effective, but invasive treatment method for an intractable groin lymphocele. …
NAID 10030353143

Risk factors for pelvic lymphoceles post-radical prostatectomy

KHODER Wael Y,TROTTMANN Matthias,BUCHNER Alexander,STUBER Andrea,HOFFMANN Sabine,STIEF Christian G,BECKER Armin J
International journal of urology 18(9), 638-643, 2011-09-01
NAID 10030823501

Related Pictures

Lymphocele; Cyst, Lymphatic; Lymphatic Cyst Lymphocele Causes in the Human Body What are lymphocele symptoms | Lymphatic & Endocrine system articles | Body & Health C&P peritoneal - Diagnostic Medical Sonography 60d with Austin at Foothill Community General and Vascular Ultrasound Cases - StudyBlue Lymphocele images, diagnosis, treatment options, answer review - Pediatric Radiology Delayed complication of pelvic lymphocele: Ileal conduit obstruction Bankar SS, Bakshi Lymphocele; Cyst, Lymphatic; Lymphatic Cyst