Mullins Jeffrey K, Pierorazio Phillip M, Hyams Elias S, Mitchell Sally E, Allaf Mohamad E
James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Can J Urol. 2012 Jun;19(3):6250-4.
We report the outcomes of a small series of patients with refractory chylous ascites following urologic surgery treated with lymphangiography +/- sclerotherapy.
Retrospective review revealed three patients who underwent lymphangiography for prolonged lymphatic leak following urological surgery. Contrast material is injected slowly into a lymphatic vessel on the dorsum of the foot and serial imaging is used to capture the location and degree of lymphatic leak in order to guide definitive treatment. Demographic and clinical details were collected and are reported.
Three patients were identified from 2005-2008 (one following donor nephrectomy and two following retroperitoneal lymph node dissection). All patients presented with abdominal distension within 30 days of surgery. Traditional conservative measures failed in all patients. Lymphangiography localized all leaks (renal hilum, paraspinal, and retrocaval). One patient elected for successful surgical repair after localization. The remaining two patients resolved immediately following lymphangiography; one of these patients underwent percutaneous doxycycline sclerosis. With over 1 year of follow up there have been no recurrences or long term sequelae.
Lymphangiography is a valuable management option for the rare patient with chylous ascites refractory to conservative therapy. Prompt resolution of prolonged chylous ascites following lymphangiography should encourage its use in such difficult cases.
我们报告了一小系列泌尿外科手术后难治性乳糜腹水患者接受淋巴管造影术+/-硬化治疗的结果。
回顾性研究发现3例因泌尿外科手术后长期淋巴漏而接受淋巴管造影术的患者。将造影剂缓慢注入足部背侧的淋巴管，并使用系列成像来捕捉淋巴漏的位置和程度，以指导最终治疗。收集并报告了人口统计学和临床详细信息。
2005年至2008年共确定3例患者（1例在供体肾切除术后，2例在腹膜后淋巴结清扫术后）。所有患者均在术后30天内出现腹胀。所有患者的传统保守治疗均失败。淋巴管造影确定了所有漏口（肾门、脊柱旁和腔静脉后）。1例患者在定位后选择了成功的手术修复。其余2例患者在淋巴管造影后立即痊愈；其中1例患者接受了经皮强力霉素硬化治疗。经过1年多的随访，无复发或长期后遗症。
对于保守治疗难治的罕见乳糜腹水患者，淋巴管造影是一种有价值的治疗选择。淋巴管造影后长期乳糜腹水的迅速消退应促使其在这类困难病例中得到应用。
