Ohsuga Takuma, Kotani Yasushi, Takamatsu Shiro, Murakami Keisuke, Nakai Hidekatsu, Matsumura Noriomi
Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511 Japan.
Int Cancer Conf J. 2020 Jun 9;9(4):203-206. doi: 10.1007/s13691-020-00421-7. eCollection 2020 Oct.
Chylous leakage is caused by interruption of lymphatic vessels carrying triglyceride-rich lymph during para-aortic lymph node dissection in patients with gynecological malignancies. Our search of literature revealed no report like our case that the renal atrophy was late onset after healing of the chylous cyst infection. A case is 60-year-old. She was preoperatively diagnosed with endometrial cancer, endometrioid carcinoma FIGO grade 3, stage IA of the FIGO system. Laparoscopic-modified radical hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and partial omentectomy were performed. On the 16th postoperative day, a percutaneous drainage was performed, and revealed chylous effusion from the lymph cyst. The drainage tube was removed, and she discharged on the 34th postoperative day. On the 99th postoperative day, a follow-up plain CT to check for a recurrence of endometrial cancer revealed atrophy of left kidney. It is probable that the chylous leakage was the primary cause of renal atrophy. Therefore, it is crucial to prevent chylous leakage during surgery to avoid repeating the same complication again.
乳糜漏是由妇科恶性肿瘤患者在主动脉旁淋巴结清扫过程中，携带富含甘油三酯的淋巴液的淋巴管中断所致。我们检索文献发现，没有像我们这个病例这样的报道，即乳糜囊肿感染愈合后出现迟发性肾萎缩。病例为一名60岁女性。她术前被诊断为子宫内膜癌，国际妇产科联盟（FIGO）系统的子宫内膜样癌3级，FIGO分期IA期。行腹腔镜改良根治性子宫切除术、双侧输卵管卵巢切除术、盆腔及主动脉旁淋巴结清扫术和部分大网膜切除术。术后第16天，进行了经皮引流，发现淋巴囊肿有乳糜性积液。引流管拔除后，她于术后第34天出院。术后第99天，为检查子宫内膜癌复发而进行的随访平扫CT显示左肾萎缩。乳糜漏很可能是肾萎缩的主要原因。因此，在手术过程中预防乳糜漏以避免再次出现相同并发症至关重要。
