Author/Editor		Kmetec, Andrej; Pleskovič, Alojz; Kandus, Aljoša
Title		Laparoskopsko ali kirurško zdravljenje limfokele pri prejemniku presajene ledvice
Translated title		Laparoscopic or surgical treatment of lymphocoele in renal transplant recipient
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 6, št. 15
Publication year		2001
Volume		str. 133-7
Language		slo
Abstract		Background. After renal transplantation, extravasation of lymphatic fluid into the retroperitoneal space may occur. In addition to open lymph ducts, risk factors for lymphocoeles include therapy of frequent rejections and treatment with steroids, diuretics and anticoagulants. Treatment is required in patients experiencing pain and pressure on the kidney, ureter and adjacent vessels. Patients and methods. Between 1998 and the end of 2000, 132 cadaveric kidney transplantations were performed at the Department of Urology, Division of Surgery, University Medical Centre Ljubljana. In 15 (11.4%) renal transplant recipients, 5 females and 10 males, symptomatic lymphocoeles were diagnosed at one to 11 months (mean 3.5+- months) after transplantation. Eight patients were treated by open surgery and seven by laparoscopy. Classical surgical and laparoscopic technique were used to establish communication between the abdominal cavity and the retroperitoneal space via s window created in the peritoneum. Both techniques ensure continuous drainage of lymphatic fluid from the closed retroperitoneal space into the abdominal cavity, where it is resorbed. The omentum interpolated in the peritoneal window ensures continuous lymph resorption and open access to the peritoneum. Results. In eight patients, who were treated by open surgery, lymphocoeles developed as early as 2.6 +- 3 months after surgery, and in seven patients treated by laparoscopy they occured at 4.6 +- months after the operation. In the opern surgery group, one patient developed a giant lymphocoele, two had stenosis of the ureter and three showed compression of the ureter and partial compression of the renal and iliac veins. In one patient the accumulated lymphatic fluid penetrated into the groin. (Abstract truncated at 2000 characters).
Summary		Uvod. Po presaditvi ledvice se lahko pojavi iztok limfe okoli ledvice v retroperitonealni prostor. Dejavniki tveganja za nastanek limfpkele so poleg odprtih limfnih vodov še zdravljenje pogostih zavrnitvenih reakcij, steroidi, diuretiki, antikoagulantna zdravila. Zaradi bolečine, pritiska na ledvico, sečevod in okolno žilje, je potrebno ustrezno zdravljenje. Bolniki in metode. Od leta 1998 do konca leta 2000 smo na Klinčnem oddelku za urologijo Kirurške klinike KC Ljubljana napravili 132 presaditev ledvic mrtbih dajalcev. Pri 15 (11,4%) prejemnikih (5 žensk, 10 moških) je bila ugotovljena simptomatska limfokela v obdobju 1 do 11 mesecev (povprečno 3,5 +/ 4 mesece) po presaditvi ledvice. Pri 8 prejemnikih smo se odločili za kirurški prostop, pri 7 pa za laparoskopski način. Bolnike smo operirali na klasični kirurški ali laparoskopski način skozi trebušno votlino. Pri obeh metodah vzpostavimo povezavo med trebušno votlino in retroperitonealnim prostorom preko okna v peritoneju. V okno smo vstavili omentum. Oba načina nam omogočata zagotovitev trajne izpeljave limfe iz zaprtega retroperitonealnega prostora v trebušno votlino, kjer se limfa resorbira. Vstavljeni omentum v peritonealno okno omogoča stalno resorpcijo in odprto pot pretoka tekočine. Rezultati. Pri 8 prejemnikih smo se odločili za klasičen kirurški pristop, pri treh smo opazovali zgoden nastanek limfokele, že po 2,6+-3 meseca, pri 7, kjer je bil poseg laparoskopski, pa šele po 4,6 +- 4 mesecih. V skupini s kirurškim zdravljenjem je bil 1 prejemnik z izjemno veliko tekočinsko tvorbo, 2 prejemnika sta imela še zožitev sečevoda, pri 3 je bil sečevod in delno tudi ledvična in iliakalna vena stisnjena, pri 1 prejemniku je limfna tekočina prodrla v mošnjo in podkožje. (Izvleček prekinjen pri 2000 znakih).
Descriptors		KIDNEY TRANSPLANTATION LYMPHOCELE LAPAROSCOPY LAPAROTOMY TREATMENT OUTCOME