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Der Urologe

, Volume 53, Issue 7, pp 996–1000 | Cite as

Pelvine Lymphadenektomie

Komplikationsmanagement
  • D. Weckermann
Leitthema

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.

Schlüsselwörter

Obturatoriusläsion Lymphozele Prostatakarzinom Harnblasenkarzinom Lymphozelenfensterung 

Pelvic lymph node dissection

Complication management

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.

Keywords

Injury of the obturator nerve Lymphocele Prostate cancer Bladder cancer Fenestration of lymphocele 

Notes

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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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Urologische KlinikKlinikum AugsburgAugsburgDeutschland

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