[Application of direct lymphangiography in the diagnosis of primary chyluria].

OBJECTIVE: To discuss the role of direct lymphangiography in the diagnosis of primary chyluria. METHODS: Iodized oil was infused into lymphatic vessel of unilateral foot in 25 cases. The condition of lymphatic system imaging was dynamically observed via Innova 2100-IQ digital flat-panel angiography system. RESULTS: All of them underwent direct lymphangiography. The results revealed unilateral (n = 18) or bilateral (n = 7) renal reflux of contrast media. Among 22 stenotic cases, there were partial (n = 18) or whole (n = 4) cervical section of thoracic duct, no imaging in cervicothoracic section of thoracic duct (n = 1); thin imaging in cervical section and partial thoracic section (n = 2); retroperitoneal lymphangictasia & tortuous lymphatic vessels (n = 21); reflux of contrast medium to pelvic and/or contralateral sacroiliac part (n = 13). CONCLUSION: Capable of acquiring dynamic images of chyle (lymph) circulation, direct lymphangiography provides accurate estimation for the location, scope, extent of lesions of renal chylous reflux in primary chyluria so as to guide surgery. Stenotic cervical section of thoracic duct plays an important etiologic role in primary chyluria.

[The diagnosis and therapy of chylous ascites].

OBJECTIVE: To discuss the diagnosis and therapy of chylous ascites. METHODS: To diagnose 40 patients of chylous ascite with regular test and quantitative analysis of chyle, direct lymphangiography, CT (immediately after direct lymphangiography), lymphangioscintigraphy, MRI. Twenty-two patients received conservative therapy, 18 patients received retroperitoneal lymphangiectomy and (or) lymph-vein shunting. RESULTS: Lymphatic dysplasia and chylous reflux were found in almost every patient, total parenteral nutrition showed good results. Followed up from 1 month to 5 years, in conservative therapy group, 9 patients were controlled well clinically, the condition of 6 patients was improved better. Seven patients showed no effect. In operation group, 11 patients were controlled well clinically. Four patients got mitigated. Total 7 patients died, although 4 of them ameliorated temporarily. CONCLUSIONS: Direct lymphangiography, CT (immediately after direct lymphangiography) are the most important diagnosis methods. The influence of the therapy to the malformed lymphatic system of patients should be well considered. Lymph-vein shunting, such as thoracic duct-left external jugular vein anastomosis, gastroenteral or retroperitoneal lymphatics-testicular or ovarian vein anastomosis, could improve the circulation of lymph and chyle of patients. Lymphatic microsurgery will play more and more important roles in the treatment of chylous diseases.