Tandon Vipul, Singh Harbans, Dwivedi U S, Mahmood Mufti, Singh P B
Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Int J Urol. 2004 Apr;11(4):193-8; discussion 199. doi: 10.1111/j.1442-2042.2003.00761.x.
Filariasis is an endemic problem in various Indian states. We evaluated the results of long-term follow up (10-20 years) of patients with filarial chyluria.
We conducted a retrospective analysis of 160 patients treated for filarial chyluria who presented to the Banaras Hindu University Hospital from 1982 to 1992. Eighty-four patients (52.5%) were treated using diethylcarbamazine (DEC) and a fat restricted diet and 76 patients (47.5%) underwent surgery. To examine the long-term effects of filarial chyluria we analysed data on post-treatment recurrence, weight gain, dietary freedom, chyluria free period and a number of other associated factors.
Previous history of filariasis or its complication was documented in 19% of patients. In 71% of cases, cystoscopy showed that chylous efflux was predominant in the left ureteric orifice. The long-term remission rate was 62% in the conservatively managed group (DEC + fat restricted diet), whereas 90% of patients in the operated group were cured. Postoperative recurrence rate was 10%. There was more weight gain and dietary freedom along with a longer chyluria free period in the operated group relative to the conservatively managed group.
Definitive surgical ablation of lymphatic urinary fistula is better than conservative medical management because it has a higher success rate, more dietary freedom and, therefore, better patient acceptability.
丝虫病是印度多个邦的地方病问题。我们评估了丝虫性乳糜尿患者长期随访（10 - 20年）的结果。
我们对1982年至1992年在贝拿勒斯印度教大学医院接受治疗的160例丝虫性乳糜尿患者进行了回顾性分析。84例患者（52.5%）采用乙胺嗪（DEC）和低脂饮食治疗，76例患者（47.5%）接受了手术治疗。为了研究丝虫性乳糜尿的长期影响，我们分析了治疗后复发、体重增加、饮食自由度、无乳糜尿期以及其他一些相关因素的数据。
19%的患者有丝虫病或其并发症的既往史。在71%的病例中，膀胱镜检查显示乳糜液流出主要在左输尿管口。保守治疗组（DEC + 低脂饮食）的长期缓解率为62%，而手术组90%的患者治愈。术后复发率为10%。与保守治疗组相比，手术组体重增加更多，饮食自由度更高，无乳糜尿期更长。
淋巴管尿瘘的确定性手术切除优于保守药物治疗，因为其成功率更高，饮食自由度更高，因此患者接受度更好。
