Castillo Octavio A, Borgna Vincenzo
Departamento de Urología y Centro de Cirugía Robótica. Clínica INDISA.
Arch Esp Urol. 2014 Nov;67(9):759-63.
Chylous ascites and high-output chylous fistula are rare complications following abdominal or pelvic surgery. We report a series of five cases that occurred after pelvic lymph node dissection for urological cancer, in addition to their clinical presentation, diagnosis, and treatment.
The series comprises five patients; four men in whom robotic radical prostatectomy and extended pelvic lymphadenectomy were performed, and one woman with an infiltrating bladder cancer that underwent robotic anterior pelvic exenteration and extended pelvic lymphadenectomy. The first four patients developed chylous ascites, and the female patient a high-output chylous fistula.
In all cases, diagnosis of chylous ascites or chylous fistula was confirmed, and they were handled in varied ways, from observation to medical treatment, paracentesis, and surgery, according to their clinical presentation and evolution. We describe a simple treatment algorithm.
This rare surgical complication requires a grade of suspicion and a defined treatment according to the probability of the medical compromise. Prevention is an important element. This series, according to our knowledge, is the first description in patients undergoing robotic extended pelvic lymphadenectomy.
乳糜腹水和高流量乳糜瘘是腹部或盆腔手术后罕见的并发症。我们报告了一系列5例在泌尿外科癌症盆腔淋巴结清扫术后发生的病例，以及它们的临床表现、诊断和治疗情况。
该系列包括5名患者；4名男性接受了机器人辅助根治性前列腺切除术和扩大盆腔淋巴结清扫术，1名患有浸润性膀胱癌的女性接受了机器人辅助前盆腔脏器清除术和扩大盆腔淋巴结清扫术。前4例患者出现乳糜腹水，女性患者出现高流量乳糜瘘。
在所有病例中，乳糜腹水或乳糜瘘的诊断均得到证实，并根据其临床表现和病情发展，从观察到药物治疗、腹腔穿刺和手术等多种方式进行处理。我们描述了一种简单的治疗方案。
这种罕见的手术并发症需要一定程度的怀疑，并根据医疗风险的可能性进行明确的治疗。预防是一个重要因素。据我们所知，该系列是对接受机器人辅助扩大盆腔淋巴结清扫术患者的首次描述。
