经皮肾镜取石术并发乳糜尿的诊治:附1例报告并文献复习

目的探讨经皮肾镜取石术(PCNL)并发乳糜尿的临床特点及治疗方法。方法回顾性分析2011年5月收治的1例PCNL并发乳糜尿的临床资料,并进行文献复习。患者,女,64岁,因左肾盂肾下盏结石行左侧微通道PCNL,术后当天发现左肾造瘘管和尿管均引出乳白色尿液,尿乳糜尿试验(+++),左肾造瘘管造影显示左肾周丰富的淋巴管显影。通过逆行插入肾盂输尿管连接部封堵器堵塞左输尿管上段,经左肾造瘘管注入2%硝酸银溶液15ml,每次留置10min,共3次。结果术后左肾造瘘管引流尿液变清,尿乳糜尿试验(-),随访9个月未见乳糜尿复发。结论经皮肾镜取石术并发乳糜尿较罕见,确诊依靠其临床表现、乳糜尿试验及相关影像学检查,低脂饮食、肾盂内硬化剂灌注和肾蒂淋巴管结扎术为其可选的治疗方法。

Chyluria after percutaneous nephrolithotomy:a case report and literature review

Objective To evaluate the clinical characteristics and treatment of chyluria after percutaneous nephrolithotomy(PCNL).Methods A 64-year-old female patient with chyluria after PCNL was reported.The calculi were in left renal pelvis and lower calyx and minimally invasive PCNL was performed.Postoperatively,the urine in nephrostomy tube and foley catheter turned micky white.The urinalysis was consistent with lymph.Plenty of lymphatic vessels around the kidney were shown in antegrade urography via nephrostomy tube.Silver nitrate instillation into renal pelvis via nephrosomy tube was performed.Results Chyluria disappeared immediately after the operations.No recurrence was diagnosed in this patient within the follow-up of 9 months.Conclusions Chyluria after PCNL is rare but diagnosed properly based on clinical and imaging features.Lower fat diet,renal pelvic instillation of sclerosant and renal pedicle lymphatic disconnection were the options for the treatment of chyluria.