達文西機器手臂輔助腹腔鏡根除性攝護腺切除術術後淋巴囊腫之發生率和治療經驗
許自翔1、鍾孝仁1,2,3、黃逸修1,2,3、林子平1,2,3、張延驊1,2,3、林登龍1,2,3、陳光國1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科；3書田泌尿科學研究中心
The incidence and management of lymphoceles after robotic-assisted laparoscopic radical prostatectomy
Tzu-Hsiang Hsu1, Hsiao-Jen Chung1,2,3, Eric Yi-Hsiu Huang1,2,3, Tzu-Ping Lin1,2,3, Yen-Hwa Chang1,2,3, Alex T.L. Lin1,2,3, Kuang-Kuo Chen1,2,3
1Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
2Department of Urology, School of Medicine, and 3Shu-Tien Urological Science Research Center, National Yang-Ming University
Purpose:
Lymphocele is a potential complication following pelvic lymphadenectomy. This study aimed to describe the incidence and management of symptomatic pelvic lymphoceles after performing robotic-assisted laparoscopic radical prostatectomy (RaLP) and pelvic lymphadenectomy.
Materials and Methods:
From December, 2009 to July, 2016, patients who underwent RaLP for prostate cancer in our institute were collected. Modified pelvic lymph nodes dissection was routinely performed. We reviewed electronic medical record and image among these patients for postoperative pelvic lymphocele. The incidence, sequelae and management of lymphoceles were retrospectively assessed.
Results:
A total of 431 patients underwent RaLP at our hospital and over 95 percent patients received modified pelvic lymph nodes dissection. Nineteen patients (4.4%) had postoperative pelvic lymphocele and ten patients (2.3%) developed symptomatic pelvic lymphoceles at an average time of 8.4 months (range from 3 days to 37.2 months). The main symptoms were fever and lower abdominal discomfort. Nine symptomatic patients received image-guided drainage and the cultures were sent. Five yield Staphylococcus aureus (55.6%), one yield Enterococcus faecalis (11.1%) and the rest had no bacterial growth (33.3%). The symptoms improved after intervention. One case underwent extended pelvic lymph node dissection and the JP drainage amount increased since the post-operative day 3. The drain was placed for a prolonged period up to 11 days and was removed after drainage amount decreased.
Conclusions:
The incidence of symptomatic pelvic lymphocele was 2.3% after RaLP and pelvic lymphadenectomy. Image-guided percutaneous drainage with antibiotics could treat effectively. The commonest organism isolated from symptomatic lymphocele was Staphylococcus aureus (55.6%).