Abstract:Objective:To assess the technique and result of retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of patients with intractable chyluria. Methods:Fifteen cases of chylurian were selected for retroperitoneoscopic renal pedicle lymphatic disconnection. Patient demographics, perioperative data, follow-up and prognostic information were collected. Results:Fourteen cases were successful, except one case was changed to open operation due to extensive adhesion between renal vessels and associated lymphoid tissue. The operative time ranged from 48-200 minutes( mean 119 minutes), intraoperative blood loss was minimal(mean 67 ml), two cases accepted the blood transfusion of 2 u erythrocyte and 2u plasma. The mean time of postoperative intestinal function recovery were 1.8 days, postoperative complication was one case of subcutaneous emphysema, postoperative hospital stays were 3-9 days(mean 6.3 days). Chyluria disappeared in all patients without recurrence during a follow up of 4-112 months (mean 43 months). All patients gained weight and had greatly improvement in nutritional condition. Conclusions:Retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria is an effective and efficient surgical procedure and has the advantages of less blood loss, minimal invasion, complete lymphatic vessels ligation, short hospital stay and rapid recovery. So far, it is an ideal surgical procedure for treatment of chyluria.
[1]Taylor MJ, Hoerauf A, Bockarie M. Lymphatic filariasis and onchocerciasis. Lancet, 2010,376(9747):1175-1185. [2]谢桐,凌桂明,乳糜尿发病的主要原因是淋巴系动力学改变. 中华泌尿外科杂志, 1984. 5(5):257-258. [3]Tan LB, Chiang CP, Huang CH, et al. Experiences in the treatment of chyluria in Taiwan. J Urol, 1990,144(3):710-713. [4]Shanmugam TV, Prakash JV, Sivashankar G. Povidone iodine used as a sclerosing agent in the treatment of chyluria. Br J Urol, 1998,82(4):587. [5]Terashi H, Tahara S, Shibuya H, et al. Treatment of filarial chyluria with lymphovenous shunt anastomosis: report of three cases in Japan. Plast Reconstr Surg, 2003,112(4):1049-1053. [6]Punekar SV, Kelkar AR, Prem AR, et al. Surgical disconnection of lymphorenal communication for chyluria: a 15-year experience. Br J Urol, 1997,80(6):858-863. [7]Chiu AW, Chen MT, Chang LS. Laparoscopic nephrolysis for chyluria: case report of long-term success. J Endourol, 1995,9(4):319-322. [8]Gomella LG, Shenot P, Abdel-Meguid TA. Extraperitoneal laparoscopic nephrolysis for the treatment of chyluria. Br J Urol, 1998,81(2):320-321. [9]Hemal AK, Gupta NP. Retroperitoneoscopic lymphatic management of intractable chyluria. J Urol, 2002,167(6):2473-2476. [10]Zhang X, Ye ZQ, Chen Z, et al. Comparison of open surgery versus retroperitoneoscopic approach to chyluria. J Urol, 2003,169(3):991-993.