Punekar S V, Kelkar A R, Prem A R, Deshmukh H L, Gavande P M
Department of Urology, Seth G.S. Medical College, Parel, Mumbai, India.
Br J Urol. 1997 Dec;80(6):858-63. doi: 10.1046/j.1464-410x.1997.00437.x.
To present the results of surgical lymphorenal disconnection and its advantages in patients with severe chyluria.
Seventy-eight patients (40 men and 38 women, age 22-58 years) with severe chyluria of variable duration (5 months to 14 years), underwent surgical disconnection of the lymphorenal communication after confirming the diagnosis of chyluria by urine examination for fat globules, lymphangiography to delineate the side, site and extent of lymphorenal communication, and cystoscopy to decide the side to be operated. The areolar tissue containing dilated lymphatics travelling to the kidney in the perirenal and hilar region was dissected and divided between ligatures, thus stripping these structures completely; only one side was operated at a time.
All 78 patients were available for a minimum follow-up of 1 year, with the longest follow-up 15 years. Lymphangiography showed unilateral communication in 52 (66%) and bilateral in 26 (34%). If the patient was given a high-fat meal before surgery, the intra-operative visualization of the lymphatics was improved. With unilateral surgery, clearance was achieved in 74 (94%) immediately, with final success in 69 (88%) patients. Of the 26 (34%) patients with bilateral lesions, nine (12%) required bilateral surgery, giving a clearance rate of 97%. In two cases of failure, repeat surgery was successful in one; thus the overall success rate was 98%.
Lymphorenal disconnection for chyluria is simple, successful as a permanent cure and with almost negligible complications. Bilateral lymphorenal communication seen on lymphangiography does not always warrant bilateral surgery.
介绍手术性淋巴肾断流术的结果及其在重症乳糜尿患者中的优势。
78例患者（男40例，女38例，年龄22 - 58岁）患有不同病程（5个月至14年）的重症乳糜尿，在通过尿液脂肪球检查确诊乳糜尿、淋巴管造影确定淋巴肾交通的侧别、部位和范围以及膀胱镜检查确定手术侧别后，接受了淋巴肾交通的手术断流。在肾周和肾门区域解剖并结扎包含扩张淋巴管的疏松结缔组织，这些淋巴管通向肾脏，从而完全剥离这些结构；每次仅对一侧进行手术。
所有78例患者均获得至少1年的随访，最长随访时间为15年。淋巴管造影显示单侧交通52例（66%），双侧交通26例（34%）。如果患者在手术前给予高脂餐，术中淋巴管的可视化效果会改善。单侧手术时，74例（94%）立即实现清除，最终69例（88%）患者成功。在26例（34%）双侧病变患者中，9例（12%）需要双侧手术，清除率为97%。在2例失败病例中，1例再次手术成功；因此总体成功率为98%。
乳糜尿的淋巴肾断流术操作简单，作为一种永久性治疗方法成功率高，并发症几乎可以忽略不计。淋巴管造影显示的双侧淋巴肾交通并不总是需要双侧手术。
