Gagliano Massimiliano, Veroux Pierfrancesco, Corona Daniela, Cannizzaro Matteo Angelo, Giuffrida Giuseppe, Giaquinta Alessia, Veroux Massimiliano
Vascular Surgery and Organ Transplant Unit, Department of Surgery, Transplantation and Advanced technologies, University Hospital of Catania, Italy.
Ann Ital Chir. 2011 Nov-Dec;82(6):499-503.
Kidney transplantation is a therapeutic option of choice for patients with end-stage disease. Laparoscopic living donor nephrectomy (LLDN) is a less invasive alternative to the open procedure to increase the number of renal donors. However, several studies have reported that this technique requires a long learning curve, and that the complication rate varies from 6.4% to 16.5%. Among these, chylous ascites (CA) is a severe and rare complications of LLDN. The treatment option for this condition is primarily conservative. Surgery is considered after failure of conservative treatment and its role, however, remains controversial. We report a case of CA as a complication of laparoscopic donor nephrectomy. A 44 year old woman underwent LLDN of the left kidney. There were no intraoperative or immediate postoperative complications and the patient was discharged home on postoperative day 3. Two weeks after discharge, the patient returned for a routine follow-up visit and presented with abdominal distension, discomfort, and dyspnea. A CT scan of the abdomen with oral and intravenous contrast revealed significant ascites in all four quadrants of abdomen and pelvis. An ultrasound guided paracentesis was performed, and 7 L of chyle was aspirated Conservative management with medium chain triglyceride and spironolactone was immediately initiated; the symptoms improved after paracentesis, and the CA completely resolved after 3 days of therapy. However, to prevent recurrence, the patient consumed a low-fat medium chain triglyceride diet for 6 months. CA needs to be considered as a potential severe and rare complication of LLDN, and conservative management should be proposed to all patients, reserving the surgical treatment to treatment failure.
肾移植是终末期肾病患者的首选治疗方案。腹腔镜活体供肾切除术（LLDN）是一种侵入性较小的替代开放手术的方法，可增加肾供体数量。然而，多项研究报告称，这项技术需要较长的学习曲线，并发症发生率在6.4%至16.5%之间。其中，乳糜性腹水（CA）是LLDN的一种严重且罕见的并发症。这种情况的治疗选择主要是保守治疗。保守治疗失败后考虑手术治疗，但其作用仍存在争议。我们报告一例CA作为腹腔镜供肾切除术并发症的病例。一名44岁女性接受了左肾LLDN。术中及术后即刻均无并发症，患者于术后第3天出院。出院两周后，患者因常规随访复诊，出现腹胀、不适和呼吸困难。口服及静脉造影剂增强的腹部CT扫描显示腹部和盆腔所有四个象限均有大量腹水。进行了超声引导下腹腔穿刺，抽出7升乳糜。立即开始采用中链甘油三酯和螺内酯进行保守治疗；穿刺后症状改善，治疗3天后CA完全消退。然而，为防止复发，患者食用低脂中链甘油三酯饮食6个月。CA需要被视为LLDN潜在的严重且罕见的并发症，应向所有患者推荐保守治疗，手术治疗仅用于治疗失败的情况。
