신이식후 발생한 증상성 림프류의 중재적 치료

Abstract

From November 1982 through March 1992, 210 living donor kidney transplantation were performed at the Keimyung University Hospital. 23 patients (11%) developed symptomatic lymphoceles 5 to 28 days after transplantation with a mean of 11.7±5.9 days. Ultrasonography, percutaneous aspiration and chemical analysis of fluid were done for the diagnosis of lymphoceles. 20(87%) of 23 lymphoceles were localized to allografts and three(13%) were of diffuse form. Clinical signs and symptoms associated with lymphocele included hypertension in 20 patients(87%), lower abdominal swelling in 17 patients(73.9%), decreased renal function in 16 patients(69.6%), transient proteinuria in 8 patients(34.8%), decreased urine volume in 6 patients(26.1%) and concurrent rejections in 4 patients(17.4%). Three methods of treatment were used as an initial therapy for lymphocele. Group I(10 patients)： clinical observation only, Group II(9 patients)： repeated percutaneous aspiration, Group III(4 patients)： percutaneous external catheter drainage. Subsequent treatment was needed in 11 patients(3 patients from group I, 4 from group II, and 4 from group III). Subsequent treatment consisted of repeated aspiration, external catheter drainage with sclerosing therapy, and external open surgical drainage. 12 patients(52%) were cured after initial therapy, however 11 patients resolved after subsequent therapy. Average duration to complete resolution was 32.0 ± 19.5(10~85) days after initial diagnosis. Complications were abscess formation in four patients and wound disruption in one patients. No renal allograft was lost as a result of a fluid collection or by complications of treatment. We concluded that symptoms of lymphocele after renal transplantation may mimic acute allograft rejection and the lymphocele can be safely treated interventionally without marsupialization.