关键词: 乳糜尿, 淋巴管, 腹腔镜检查, 腹膜后间隙, 泌尿外科手术

Abstract:

Objective： To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications. Methods: From August 2013 to June 2008, five patients with chyluria were admitted. All the patients were female,  aged from 26 to 73 years， and disease course from 1 to 10 years．All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss, and fatigue, of whom two presented with flank pain and one with anemia. Their urine chyle tests were confirmed to be positive. Preoperative cystoscopy found that chyluria was from the left side in 3 cases，and from the right side in 2 cases．Their proteinuria ranged from+to++++. All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extraadiposecapsule without disconnection of perirenal fat tissues. The operation time, intraoperative blood loss, postoperative intestinal function recovery, catheter time, drainage tube removal time and complications during operation were collected.  Results: All the five cases were performed successfully. The operation time ranged from 75 to 170 minutes, mean (126.0±39.6) minutes, with the intraoperative blood loss 20 to 60 mL, mean (38.0±16.4) mL, and the postoperative intestinal function recovery time 1 to 3 days, mean (1.9±0.4) days. The catheter time was 1 to 4 days, mean (2.1±0.3) days and the drainage tube removal time ranged from 3 to 15 days, mean (9.3±1.8) days. Postoperatively lymphorrhagia was found in two cases. No renal vessels injury occurred during operation. Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery. Furthermore, urine test revealed that proteinuria was totally negative. No recurrence was detected in our patients in the 9 to 31 months’ follow-up. Conclusion: This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation. It was characterized with shorter operation time, definitive effect and fewer complications.

Key words: Chyluria, Lymphatic vessels, Laparoscopy, Retroperitoneal space, Urologic surgical procedures