Objective To report our experiences in retroperitonescopic renal pedicle lymphatic stripping for chyluria.Methods Six cases of filarial chyluria were admitted to our hospital from November 2001 to June 2002. Of these ...Objective To report our experiences in retroperitonescopic renal pedicle lymphatic stripping for chyluria.Methods Six cases of filarial chyluria were admitted to our hospital from November 2001 to June 2002. Of these cases, 4 were men and 2 women, with age ranging from 34 to 52 years (mean, 42 years) . Diagnosis was made by using urine test for the presence of chyle and fat globule, cystoscopy, excretory urogram and retrograde pyelography. Chyluria was found on the left renal unit in 2 cases and on the right side in 4 cases. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, hilar vessel stripping and ureterolympholysis.Results Operative time ranged from 69 to 120 minutes (mean, 95 minutes). Intraoperative blood loss was 50 -180 ml (mean, 85 ml). Chyluria disappeared in all patients immediately after operation. Mild hematuria occurred in 4 cases within 12 hours and disappeared at 24 hours. Subcutaneous emphysema around the lesions was found in 2 cases and was spontaneously absorbed 3 days after the treatment. There was no lymphatic leak at the lesions. The patients were discharged from the hospital 5-9 days after the treatment. All patients gained weight and their haemoglobin and serum protein increased by 13. 5 g/L and 3. 66 g/L respectively. No chyluria recurrence was reported during 1-1.6 years follow-up.Conclusions Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is a safe, effective and efficient surgical procedure with minimal invasion, less pain, lower morbidity, short hospital stay and rapid recovery.展开更多
BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and manage...BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and management strategies.METHODS The systematic review was performed through PubMed,MEDLINE,EMBASE and Cochrane and cross-checked up to November 2020.The data collated included:Demographics,indications(benign vs malignant),site of disease,surgical approach,extent of lymphadenectomy,day to and method of diagnosis of chylous ascites and management strategies.RESULTS A total of 28 studies were included in the final analysis(426 cases).Patient age ranged from 31 to 89 years.All except one case were performed for malignancy.Of the 426 cases,195 were right-colonic,121 left-colonic,103 pelvic surgeries and 7 others.The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume.Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis.Most cases were managed successfully non-operatively(fasting with prolonged drainage,total parenteral nutrition,somatostatin analogues or a combination of these).Only three cases required surgical intervention after failing conservative management and subsequently resolved completely.Risk factors identified include:Right-colonic surgery/tumour location,extent of lymphadenectomy and number of lymph nodes harvested.CONCLUSION Chylous ascites after colorectal surgery is a relatively rare complication.Whilst the majority of cases resolved without surgical intervention,preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.展开更多
Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rare...Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.展开更多
文摘Objective To report our experiences in retroperitonescopic renal pedicle lymphatic stripping for chyluria.Methods Six cases of filarial chyluria were admitted to our hospital from November 2001 to June 2002. Of these cases, 4 were men and 2 women, with age ranging from 34 to 52 years (mean, 42 years) . Diagnosis was made by using urine test for the presence of chyle and fat globule, cystoscopy, excretory urogram and retrograde pyelography. Chyluria was found on the left renal unit in 2 cases and on the right side in 4 cases. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, hilar vessel stripping and ureterolympholysis.Results Operative time ranged from 69 to 120 minutes (mean, 95 minutes). Intraoperative blood loss was 50 -180 ml (mean, 85 ml). Chyluria disappeared in all patients immediately after operation. Mild hematuria occurred in 4 cases within 12 hours and disappeared at 24 hours. Subcutaneous emphysema around the lesions was found in 2 cases and was spontaneously absorbed 3 days after the treatment. There was no lymphatic leak at the lesions. The patients were discharged from the hospital 5-9 days after the treatment. All patients gained weight and their haemoglobin and serum protein increased by 13. 5 g/L and 3. 66 g/L respectively. No chyluria recurrence was reported during 1-1.6 years follow-up.Conclusions Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is a safe, effective and efficient surgical procedure with minimal invasion, less pain, lower morbidity, short hospital stay and rapid recovery.
文摘BACKGROUND Chylous ascites is a rare complication in colorectal surgery with limited evidence.AIM To systematically review all available evidence to describe the incidence,clinical presentation,risk factors and management strategies.METHODS The systematic review was performed through PubMed,MEDLINE,EMBASE and Cochrane and cross-checked up to November 2020.The data collated included:Demographics,indications(benign vs malignant),site of disease,surgical approach,extent of lymphadenectomy,day to and method of diagnosis of chylous ascites and management strategies.RESULTS A total of 28 studies were included in the final analysis(426 cases).Patient age ranged from 31 to 89 years.All except one case were performed for malignancy.Of the 426 cases,195 were right-colonic,121 left-colonic,103 pelvic surgeries and 7 others.The majority were diagnosed during the same inpatient stay by recognition of typical drain appearance and increased volume.Three cases were diagnosed during outpatient visits with increased abdominal distention and subsequently underwent paracentesis.Most cases were managed successfully non-operatively(fasting with prolonged drainage,total parenteral nutrition,somatostatin analogues or a combination of these).Only three cases required surgical intervention after failing conservative management and subsequently resolved completely.Risk factors identified include:Right-colonic surgery/tumour location,extent of lymphadenectomy and number of lymph nodes harvested.CONCLUSION Chylous ascites after colorectal surgery is a relatively rare complication.Whilst the majority of cases resolved without surgical intervention,preventative measures should be undertaken such as meticulous dissection and clipping of lymphatics during lymphadenectomy to prevent morbidity.
基金Supported by the National Natural Science Foundation of China,No.30224801
文摘Acute abdominal pain with signs and symptoms of peritonitis due to sudden extravasation of chyle into the peritoneal cavity is a rare condition that is often mistaken for other disease processes. The diagnosis is rarely suspected preoperatively. We report a case of spontaneous chylous peritonitis that presented with typical symptoms of acute appendicitis such as intermittent fever and epigastric pain radiating to the lower right abdominal quadrant before admission.
