Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabasou, Amagasaki, Hyogo, 660-8511, Japan,
Surg Today. 2014 Apr;44(4):757-60. doi: 10.1007/s00595-012-0443-y. Epub 2012 Dec 11.
Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced esophageal cancer and regional lymph node metastases. After receiving neoadjuvant chemotherapy to control the regional lymph node metastases, the patient underwent transthoracic excision of the esophagus assisted by thoracoscopy, with excision of the azygos vein and thoracic duct, esophagostomy and tube gastrostomy. On postoperative day 22, the urine appeared ivory white in color, and urine tests showed a high triglyceride level, thus confirming the diagnosis of chyluria. The chyluria decreased temporarily after switching the patient from enteral nutrition (EN) to parental nutrition, but it emerged again after the resumption of EN. Lymphangiography at that stage showed the flow of lipiodol into the pelvis of the left kidney. Resolution of the chyluria was noted after lymphangiography. He underwent esophageal reconstruction with a gastric tube through an anterior mediastinal route, and was discharged 36 days after the second operation. He was thereafter followed up at the outpatient clinic with radiotherapy.
乳糜尿是淋巴液漏入尿液，继发于淋巴系统损伤或阻塞。本文报告了一例食管癌根治术后乳糜尿的罕见病例。一名 69 岁男性因上腹痛和反流症状就诊，被诊断为晚期食管癌和区域淋巴结转移。在接受新辅助化疗控制区域淋巴结转移后，患者接受了胸腔镜辅助下经胸食管切除术，切除奇静脉和胸导管，进行食管造口术和管胃造口术。术后第 22 天，患者尿液呈乳白色，尿液检查显示甘油三酯水平升高，从而确诊为乳糜尿。患者从肠内营养（EN）转换为肠外营养（PN）后，乳糜尿暂时减少，但恢复 EN 后再次出现。当时的淋巴管造影显示碘化油流入左肾盆腔。淋巴管造影后乳糜尿得到缓解。他通过前纵隔途径用胃管进行了食管重建，第二次手术后 36 天出院。此后，他在门诊接受放疗随访。
