76%泛影葡胺肾盂灌注联合体外冲击波治疗乳糜尿6例报告

Renal Pelvic Instillation of 76% Meglumine Diatrizoate Combined with Extracorporeal Shock Wave for Chyluria:Report of 6 Cases

目的探讨泛影葡胺肾盂灌注联合体外冲击波(ESW)治疗乳糜尿的有效性及安全性。方法 2007年6月～2011年12月,6例确诊为乳糜尿,均无确诊血丝虫病,其中1例有丝虫病区生活史,2例有左侧腹股沟大隐静脉淋巴吻合手术史。膀胱镜下确定乳糜尿患侧,逆行插入F5输尿管外支架管后采用76%泛影葡胺经导管低压肾盂灌注,了解造影剂有无反流和肾窦位置后,行ESW冲击造影剂外渗部位通道。结果 6例均见到肾盂、肾盏淋巴反流通道,ESW一次治疗成功,术中、术后未出现感染、包膜下血肿等。随访3～37个月,平均18个月,均无复发,无高血压等远期并发症出现。结论泛影葡胺肾盂灌注联合ESW治疗乳糜尿的效果好,安全,患者依从性良好,可作为该病的常规治疗手段。

Objective To evaluate the safety and efficacy of 76% meglumine diatrizoate for renal pelvic instillation combined with extracorporeal shock wave （ESW） in the treatment of chyluria. Methods From June 2007 to December 2011, totally 6 cases of chyluria were admitted to our hospital. None of the patients were diagnosed with filariasis. Among the patients, one had lived in filariasis endemic area, and two had received left inguinal saphenous vein lymphatic anastomosis. With the lesion been positioned with cystoscopy, we instilled 76% meglumine diatrizoate into the renal pelvis through a F5 ureteral catheter, and then ESWL was used on the contrast agent extravasating channel. Results Pelvicalyceal lymphatic channel was observed in all the 6 cases, who were cured in one session by ESW. No infection or subcapsular hematoma occurred during and after the operation. The patients were followed up for 3 to 37 months with a mean of 18 months, during which no recurrence, or long-term complications （such as hypertension） occurred. Conclusions Renal pelvic instillation of 76% meglumine diatrizoate combined with ESW is effective and safe for chyluria. The procedure is well tolerated by patients, and thus can be used as a routine therapy.