摘要
目的探讨足背淋巴管造影(PLG)在乳糜尿患者术前定位和治疗中的作用。方法回顾性分析2010年10月至2017年3月收治的25例行膀胱镜检查和单侧PLG检查经保守治疗无效的乳糜尿患者的临床资料,其中上海市浦南医院18例,上海交通大学附属瑞金医院卢湾分院7例。男11例,女14例;年龄44-71岁,平均58.5岁。病程0.5-30.0年,平均8.3年。其中18例PLG时联合螺旋CT血管造影,根据PLG影像学结果行肾蒂淋巴管结扎剥脱术治疗。结果19例单侧乳糜尿患者中膀胱镜发现单侧输尿管喷乳糜16例,定位诊断的敏感性为84.2%(16/19);6例双侧乳糜尿患者中发现单侧输尿管喷乳糜4例(66.7%);5例仅见膀胱内乳白色尿,未见输尿管喷乳糜,膀胱镜对乳糜尿患者定位诊断的总敏感性为64.5%(20/31)。PLG对19例单侧乳糜尿患者及6例双侧乳糜尿患者的病变部位均能正确显示,敏感性为100.0%(31/31),膀胱镜与PLG在19例单侧乳糜尿患者定位诊断的敏感性相比差异无统计学意义(P=0.248),但在单、双侧乳糜尿患者总病变定位方面,PLG的敏感性高于膀胱镜检查(P〈0.001)。18例PLG联合螺旋CT血管造影除具有类似PLG发现淋巴瘘部位的功能之外,还能显示病变淋巴管沿多支肾动脉、肾静脉反流入肾。25例乳糜尿患者根据PLG或PLG联合螺旋CT血管造影结果行单侧肾蒂淋巴管结扎剥脱术,23例术后乳糜尿立即消失,2例双侧乳糜尿患者无效,3个月后再次行PLG证实对侧淋巴肾盂瘘,经对侧手术后乳糜尿消失。术后随访6-58个月,平均28.5个月。复发6例,其中4例为双侧乳靡尿患者,再次行PLG证实为对侧淋巴肾盂瘘所致,通过行腹腔镜和开放手术各治愈1例,余2例PLG后乳糜尿逐渐消失,予观察。2例单侧乳靡尿患者术后复发,均为腹腔镜手术后,再次行PLG证实为手术同侧复发,给予体外冲击波治疗治�
ObjectiveTo evaluate the use of unilateral pedicle lymphography(PLG) in preoperative localization and treatment of chyluria.MethodsFrom October 2010 to March 2017, 25 cases with severe chyluria and undergoing cystoscopy and unilateral PLG before renal pedicle lymphatic disconnection were reviewed. There were 11 males and 14 females, aged 44-71 years, with an average of 58.5 years. The course of the disease was 6 months to 30 years, with an average of 8.3 years.Of them, 18 cases had undergone unilateral PLG and spiral CT angiography preoperatively. Surgical treatment was performed according to PLG imaging.ResultsUnilateral ureteral chyluria was discovered in 16 out of the 19 cases through cystoscopy, with the sensitivity of 84.2%(16/19). In contrast, unilateral chyluria was only detected in 4 of the other 6 patients with bilateral chyluria. Albiduria were found in the remaining 5 cases in bladder, without ureteral excreted chyle. The sensitivity for chyluria positioning by cystoscopy was 64.5%(20/31). The location of lesion in 19 patients with unilateral chyuria and 6 patients with bilateral chyluria could be correctly displayed by PLG and the sensitivity was 100%(31/31). There was no significant difference in location between cystoscopy and PLG in 19 patients with unilateral chyluria (P=0.2482). But in total lesion location, the sensitivity of PLG was higher than cystoscopy(P=0.0026). Eighteen patients who had undergone PLG combined with spiral CT angiography, could not only locate the chylous fistula, but also determine the number of renal vessels as well as their relationship with diseased lymphatic vessels. Chyluria had disappeared immediately after unilateral renal pedicle lymphatic exfoliation in 23 patients. However, it still presented in the other 2 patients who were confirmed contralateral pyeloymphatic fistulas by PLG 3 months after surgery and cured by reoperation. Chyluria recurred in 6 cases during follow-up of 6 to 58 months, and 4 were confirmed bilateral pyelolymphatic fistu
作者
刘定益
夏维木
王健
黄海栋
唐崎
周燕峰
俞家顺
李文敏
王名伟
夏宇
周文龙
Liu Dingyi;Xia Weimu;Wang Jian;Huang Haidong;Tang Qi;Zhou Yanfeng;Yu Jiashun;Li Wenmin;Wang Mingwei;Xia Yu;Zhou Wenlong(Department of Urology, Shanghai Punan Hospital, Shanghai 200125, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第6期446-450,共5页
Chinese Journal of Urology
基金
上海浦东新区卫生系统重点学科基金(PWZx-2014-19)