機械手臂輔助根除性攝護腺切除及雙側骨盆淋巴清除術後雙側淋巴液漏　

案例報告

沈運筑、王百孚

彰化基督教醫院 外科部 泌尿科

Lymphorrhea after robot-assisted radical prostatectomy and pelvic lymph node dissection 

case report

Yun-Chu Shen, Bai-Fu Wang

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan;

A 66-year-old male presented with weak stream of urination for several years. Serum PSA was 9.47 ng/mL, transrectal ultrasound showed moderate enlarged prostate. Transrectal prostate biopsy was performed. Pathlogy report showed adenocarcinoma, Gleason score 3+3=6(Grade group 1). Bone scan revealed no definite evidence of bone metastasis. MRI result was compatible with prostatic cancer over bilateral lobe, T2cN0M0. He was admitted initially for robot-assisted laparoscopic radical prostatectomy with bilateral nerve sparing and pelvic lymph node dissection on 2017-09-20. The drainage tube was placed over the site of anastomosis. Intermittent right lower abdominal pain was complained during admission. The drainage amount was 135ml on post-operative day 1 and day 2, then increased to more than 200 ml since post-operative day 3.

Sudden onset left flank soreness pain was noted since post-operative day 8. Renal ultrasound showed right mild hydronephrosis. Elevated serum creatinine was also noted. Right leg swelling and abdominal distention was complained since post-operative day 13. Abdominal CT was arranged.