Background: Lymph node dissection (LND) is often performed in genitourinary cancer to improve accurate staging. However, the resultant lymphatic damage often leads to postoperative lymphorrhea and chylorrhea. Further, since lymphatic fluid lacks platelets, it has very few clotting factors, and it is often difficult to treat postoperative lymphatic leakage. Treatments for lymphorrhea include conservative treatment (e.g., fasting, total parenteral nutrition, and drug therapy), interventional radiology (IR) and surgical treatment. However, there is no guideline of refractory lymphorrhea, and no clear criteria for switching to the next treatment. Methods: We reviewed the records of 28 patients at Toho University Sakura Medical Center with postoperative lymphorrhea or chylorrhea after LND that did not improve with conservative treatment. Based on this analysis, we partially revised the treatment algorithm for lymphorrhea developed by Rose et al. Results: The cases consisted of 26 men and two women, aged 65.0 ± 9.9 years. The mean number of lymph nodes removed was 25.3 ± 15.0. Octreotide was administered in 27 patients, lymphangiography was performed in three patients, and lymphatic embolization was performed in two patients. The mean duration of octreotide administration was 9.7 ± 6.1 days, and the mean dose was 211.1 µg/day. The treatment success rates with octreotide and IR were 78.6% and 100%, respectively. The mean duration of drain placement after surgery for primary cancer was 18.3 ± 14.3 days. Conclusions: Patients with lymphorrhea and chylorrhea should be initially treated conservatively, with IR performed if conservative treatment is unsuccessful. Surgical treatment should be a last resort.
背景：泌尿生殖系统肿瘤手术中常行淋巴结清扫术以提高分期准确性，但由此造成的淋巴系统损伤常导致术后淋巴漏及乳糜漏。由于淋巴液缺乏血小板且凝血因子含量极低，术后淋巴漏往往难以处理。当前治疗手段包括保守治疗（如禁食、全肠外营养及药物治疗）、介入放射学治疗及外科手术干预。然而，针对难治性淋巴漏目前尚无标准化诊疗指南，亦缺乏明确的治疗转换标准。方法：本研究回顾性分析东京都立大学樱医疗中心收治的28例淋巴结清扫术后发生淋巴漏/乳糜漏且保守治疗无效患者的临床资料。基于分析结果，我们对Rose等提出的淋巴漏治疗路径进行了部分修订。结果：28例患者中男性26例、女性2例，平均年龄65.0±9.9岁，平均淋巴结清扫数量25.3±15.0枚。27例患者接受奥曲肽治疗，3例接受淋巴管造影检查，2例实施淋巴管栓塞术。奥曲肽平均用药时长9.7±6.1天，日均剂量211.1微克。奥曲肽与介入治疗的成功率分别为78.6%和100%。原发癌术后引流管平均留置时间为18.3±14.3天。结论：淋巴漏及乳糜漏患者应首选保守治疗，若保守治疗无效则建议采用介入放射学治疗，外科手术应作为最终治疗选择。
肿瘤(癌症)患者之家