Muguruma K, Matsuda T, Koyama Y, Komatz Y
Department of Urology, Kanasai Medical University.
Nihon Hinyokika Gakkai Zasshi. 1994 Oct;85(10):1571-4. doi: 10.5980/jpnjurol1989.85.1571.
Stripping and ligation of the renal lymphatics has been a standard operation for patients with chyluria in Japan. However, recently, inguinal lymph node-saphenous vein anastomosis and lymphangiovenous anastomosis in the spermatic cord or the lower limb are introduced as a microsurgical treatment of chyluria with good result from China. We present a case of 50-year-old female with chyluria, which was cured by the lymphatic-venous anastomosis at the groin. The patient had lived in Okinawa, an area of endemic filariasis, till 23 years of age. She noted chyluria for the first time at 28 years of age, when it was treated by irrigation of the renal pelvis with silver nitrate solution. The symptom recurred at 48 years of age, and fatigue developed two months before admission. The conservative treatments including rest, low fat diet and repeated irrigation of the renal pelvis were carried out, but these were ineffective. Therefore, bilateral inguinal lymph node-saphenous vein anastomosis and lymphangiovenous anastomosis in the same wound on the right were performed. The chyluria disappeared five months after the operation. The lymphatic-venous anastomosis at the superficial part of the body may be the surgical procedure of choice, because they are effective, simple, less invasive and less traumatic.
在日本，肾淋巴管剥脱结扎术一直是乳糜尿患者的标准手术方式。然而，近年来，中国开展了腹股沟淋巴结 - 大隐静脉吻合术以及精索或下肢淋巴管静脉吻合术作为乳糜尿的显微外科治疗方法，并取得了良好效果。我们报告一例50岁乳糜尿女性患者，通过腹股沟淋巴管静脉吻合术治愈。该患者23岁前生活在丝虫病流行地区冲绳。她28岁时首次发现乳糜尿，当时采用硝酸银溶液肾盂灌注治疗。48岁时症状复发，入院前两个月出现乏力。曾进行包括休息、低脂饮食及反复肾盂灌注等保守治疗，但均无效。因此，实施了双侧腹股沟淋巴结 - 大隐静脉吻合术以及右侧同一伤口内的淋巴管静脉吻合术。术后五个月乳糜尿消失。身体浅表部位的淋巴管静脉吻合术可能是首选的外科手术方式，因为其效果显著、操作简单、侵袭性小且创伤小。
