POSTOPERATİF PELVİK LENFOSELLERİN GÖRÜNTÜLEME EŞLİĞİNDE PERKÜTAN TEDAVİSİ

Öz

Amaç: Bu çalışmada, kliniğimize pelvik lenfosel ön tanısıyla gelen ve görüntüleme yöntemleri eşliğinde perkütan girişimsel olarak tedavi ettiğimiz vakalarda edindiğimiz deneyimi ve yaklaşımımızı sunmayı hedefledik.

Gereç ve Yöntemler: Bu çalışmaya 2012-2018 yılları arasında hastanemiz Girişimsel Radyoloji ünitesine batında lenfosel ön tanısıyla konsülte edilen ve perkütan yolla işlem yapılan 56 vaka dahil edilmiş olup veriler retrospektif olarak analiz edilmiştir. Hacmi 100 cc altında olanlar ile gelen içeriği hemorajik olan lenfosellere basit aspirasyon ile boşaltma veya sadece örnekleme işlemi uygulanmış olup 100 cc üzerinde olan vakalara ise skleroterapili veya skleroterapisiz perkütan kateter drenajı işlemi gerçekleştirilmiştir.

Bulgular: Hastaların yaş ortalaması 53.2 (aralık: 20-82, SD: 13.7) idi. Lenfosel hacmi ortalama 430.2 cc (aralık: 8-4500 cc, SD: 720.8) olarak ölçüldü. En sık görülen etiyolojik faktör %91 hastada (n=51) jinekolojik malignite operasyonu idi. Lenfosel hacmi >100 cc olan 45 hastaya perkütan drenaj kateteri takılmış olup bunlardan 39 hastaya etanol ile skleroterapi tedavisi uygulandı. Lenfosel hacmi <100 cc olan 11 vakadan 9’unda basit aspirasyonla drenaj sağlandı. Tedaviler sonrası 7 vakada (%12.5) rekürrens geliştiği görüldü. Başarı oranları skleroterapi uygulanan vakalarda %94.8 (37/39) ve skleroterapisiz perkütan drenaj kateteri uygulanan vakalarda ise %66.6 (4/6) olarak hesaplandı.

Sonuç: Pelvik lenfosellerin etanol ile skleroterapi tedavisi basit aspirasyon ve skleroterapisiz drenaj yöntemine göre daha etkili bir tedavi yöntemidir. Perkütan tedavilerde hastanede kalış süresi cerrahi yöntemlere kıyasla dramatik şekilde kısadır ve işlem daha az invazivdir.

Anahtar Kelimeler

• Lenfosel
• Girişimsel Radyoloji
• perkütan drenaj

Imaging-Guided Percutaneous Treatment of Postoperative Pelvic Lymphoceles

Öz

Objective: In this study, we aimed to present our experience and approach in cases with pelvic lymphocele, treated with imaging-guided percutaneous interventional therapy.

Material and Methods: In this study, 56 cases consulted with the diagnosis of lymphocele in the abdomen and treated percutaneously in the Interventional Radiology unit of our hospital between 2012-2018, were included and the data were analyzed retrospectively. The lymphoceles with a volume below 100 cc and the contents of which were hemorrhagic, were treated with simple aspiration or sampling only, and in cases over 100 cc, percutaneous catheter drainage was performed with or without sclerotherapy.

Results: The mean age of the patients was 53.2 (range: 20-82, SD: 13.7). Lymphocele average volume was measured as 430.2 cc (range: 8-4500 cc, SD: 720.8). The most common etiological factor was gynecological malignancy in 91%of patients (n=51). Percutaneous drainage catheter was placed in 45 patients with lymphocele volume >100 cc and 39 of these patients were treated with ethanol sclerotherapy. Drainage was achieved by simple aspiration in 9 of 11 cases with lymphocele volume <100 cc. Recurrence was observed in 7 cases (12.5%) after the treatments. Success rates were 94.8%(37/39) in cases undergoing sclerotherapy and 66.6%(4/6) in cases undergoing percutaneous drainage catheter without sclerotherapy.

Conclusion: Sclerotherapy of pelvic lymphoceles with ethanol is a more effective treatment method than simple aspiration and sclerotherapy-free drainage method. In percutaneous treatments, the length of hospital stay is dramatically shorter compared to surgical methods, and the procedure is less invasive.

Anahtar Kelimeler

• Lymphocele
• Interventional Radiology
• Percutaneous drainage

Kaynakça

1. 1. Zuckerman DA, Yeager TD. Percutaneous ethanol sclerotherapy of postoperative lymphoceles. American Journal of Roentgenology, 1997;169(2):433-437.
2. 2. White M, Mueller P, Ferrucci Jr J, Butch R, Simeone J, Neff C et al. Percutaneous drainage of postoperative abdominal and pelvic lymphoceles. American Journal of Roentgenology. 1985;145(5):1065-69.
3. 3. Kim JK, Jeong YY, Kim YH, Kim YC, Kang HK, Choi HS. Postoperative pelvic lymphocele: treatment with simple percutaneous catheter drainage. Radiology. 1999;212(2):390-4.
4. 4. Yang DM, Jung DH, Kim H, Kang JH, Kim SH, Kim JH et al. Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics. 2004;24(5):1353-65.
5. 5. Weinberger V, Cibula D, Zikan M. Lymphocele: prevalence and management in gynecological malignancies. Expert Review of Anticancer Therapy. 2014;14(3):307-17.
6. 6. Karcaaltincaba M, Akhan O. Radiologic imaging and percutaneous treatment of pelvic lymphocele. European Journal of Radiology, 2005;55(3):340-54.
7. 7. Akhan O, Karcaaltincaba M, Ozmen MN, Akinci D, Karcaaltincaba D, Ayhan A. Percutaneous transcatheter ethanol sclerotherapy and catheter drainage of postoperative pelvic lymphoceles. CardioVascular and Interventional Radiology. 2007;30(2):237-40.
8. 8. Mahrer A, Ramchandani P, Trerotola SO, Shlansky-Goldberg RD, Itkin M. Sclerotherapy in the management of postoperative lymphocele. Journal of Vascular and Interventional Radiology. 2010;21(7):1050-3.

9. 9. Baek Y, Won JH, Chang SJ, Ryu H, Song S, Yim B et al. Lymphatic Embolization for the Treatment of Pelvic Lymphoceles: Preliminary Experience in Five Patients. Journal of Vascular and Interventional Radiology. 2016;27(8):1170-76.
10. 10. Hur S, Shin JH, Lee IJ, Min SK, Min SI, Ahn S et al. Early experience in the management of postoperative lymphatic leakage using lipiodol lymphangiography and adjunctive glue embolization. Journal of Vascular and Interventional Radiology. 2016;27(8):1177-86.e1.