淋巴腫壓迫以深部靜脈栓塞表現，機械手臂輔助內視鏡根除性攝護腺切除術及骨盆腔淋巴結廓清術後併發症–個案報告 

 劉家睿¹、陳進利¹、蒙恩¹、顏敬恆²

 ¹國防醫學院三軍總醫院外科部泌尿外科；²三軍總醫院松山分院外科部泌尿外科

 Symptomatic lymphoceles present as deep vein thrombosis following robot‑assisted laparoscopic radical prostatectomy and pelvic lymph node dissection– a case report

Wei-Chen Yen¹ , Chin-Li Chen¹ , En Meng¹ , Ching-Heng Yen²

¹ Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan ; ² Division of Urology, Department of Surgery, Tri Service General Hospital Song-shan Branch, Taipei, Taiwan

Robotic‑assisted laparoscopic radical prostatectomy (RALP) following pelvic lymph node dissection (PLND) for prostatic cancer provides more information for further treatment planning, especially for patients with high predicted probability of lymph node metastasis. The incidence of symptomatic DVT in patients treated with RALP and PLND is 0.5%. Moreover, there is a high incidence (30%) of asymptomatic lymphoceles after PLND for prostatic cancer and the rate of symptomatic lymphocele varies between 3% and 14%. Pelvic lymphocele causes venous compression may also result in deep vein thrombosis (DVT). The standard treatment for pelvic lymphoceles is yet to be defined. Moreover, treatments are usually reserved for clinically symptomatic lymphoceles and include percutaneous drainage with or without sclerotherapy and open or laparoscopic marsupialization.

We described a 63-year-old man who underwent RALP with standard PLND without neurovascular bundle preservation for Adenocarcinoma of prostate, Gleason score 4+3, stage pT2N0M0. The heparin was not used for preventing deep vein thrombosis. Postoperative day 28, he presented our OPD with progressive swelling of right lower extremity with claudication for 2 days. The similar symptoms had occurred 10 days ago but relief spontaneously. Physical examination showed grade 2-3 pitting edema over right lower extremity. Computed tomography with contrast showed cystic lesions over bilateral iliac chain with one maximum cyst(5.8cmX6.2cm) compression over right iliac vein and right external vein filling with thrombosis. Oral factor Xa inhibitors with rivaroxaban 15mg daily was prescribed for treating deep vein thrombosis. Percutaneous aspiration of pelvic lymphoceles with catheter drainage was performed following trans-catheter sclerotherapy with 95% ethanol. The leg swelling improved and subsided. MRI follow up at 3 months later showed no recurrence.