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Pelvine Lymphadenektomie

Komplikationsmanagement

Pelvic lymph node dissection

Complication management

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Zusammenfassung

Die ausgedehnte pelvine Lymphadenektomie liefert exakte Angaben zum Lymphknotenstatus und verbessert darüber hinaus möglicherweise den Krankheitsverlauf. Diesen Vorteilen stehen mögliche peri- und postoperative Komplikationen gegenüber. Bei intraoperativer Läsion des N. obturatorius sollte eine mikrochirurgische epineurale Nervennaht erfolgen. Postoperativ sollte der Patient aufgeklärt, neurologisch vorgestellt und krankengymnastisch behandelt werden.

Die häufigste postoperative Komplikation ist die (symptomatische) Lymphozele. Sie tritt häufiger nach einem extraperitonealen Eingriff auf. Sorgfältige Präparation der Lymphknoten mit Klippung der Lymphbahnen, Aussparen der lateralen Wand der A. iliaca externa bei der Lymphknotendissektion, ausreichend lange postoperative Drainage und Applikation von niedermolekularem Heparin in den Oberarm können das Risiko für eine postoperative Lymphozele reduzieren.

Die Instillation sklerosierender Medikamente und eine längere Drainage führen in der Regel zu einem Sistieren der Lymphsekretion. Ist dies nicht der Fall, kann die laparoskopische Fensterung mit hoher Erfolgsrate die Lymphozele sanieren. Wichtig sind regelmäßige Ultraschallkontrollen im postoperativen Verlauf, um Lymphozelen rechtzeitig zu erkennen und zu behandeln.

Abstract

Extended pelvic lymph node dissection allows exact lymph node staging and has the potential to improve prognosis. In addition to these advantages, there are some perioperative and postoperative complications. In case of transection of the obturator nerve, a microsurgical end-to-end anastomosis should be performed.

The most frequent postoperative complication is (symptomatic) lymphocele which is predominantly diagnosed after extraperitoneal surgery. Meticulous lymph node dissection with clipping of lymphatic vessels, sparing the lateral wall of the external iliac artery from dissection, sufficient postoperative drainage, and application of low molecular weight heparin in the upper arm may reduce their incidence.

Instillation of sclerosing agents and sufficient drainage are normally successful. If not, laparoscopic fenestration of lymphocele should be performed. Regular ultrasound examinations are necessary to diagnose and treat postoperative lymphocele in a timely manner.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. D. Weckermann gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Urologische Klinik, Klinikum Augsburg, Stenglinstraße 2, 86156, Augsburg, Deutschland

    D. Weckermann

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Weckermann, D. Pelvine Lymphadenektomie. Urologe 53, 996–1000 (2014). https://doi.org/10.1007/s00120-014-3480-x

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  • DOI: https://doi.org/10.1007/s00120-014-3480-x

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