病例報告：腰椎清創及重建手術術後之醫源性乳糜尿

楊昀達、林承家

基隆長庚醫院 外科部 泌尿科

Case report: iatrogenic chyluira after lumbar spine debridement and reconstruction

Yun-Ta Yang, Cheng-Chia Lin

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

We report the case of a 72-year-old male who had L2-3 infectious spondylitis with paraspinal abscesses. The patient present chyluria 3-weeks after received L2-3 level anterior debridement and spinal fusion operation. Chyluria was confirmed by triglycerides urine test. The lymphoscintigraphy was performed, and lymphatic obstruction at the retroperitonum level, around the common iliac chain level was reported. Abdominal echo had no ascites or fluid accumulation found, consistent with retrograde pyelography that showed no extravasation of contrast. Fiberocystoscopy reported bladder mucosa intact without fistula. Conservative treatment with medium-chain fatty acid diet was applied and bilateral ureteral catheterization set. About 3 months later, the patient replied of chyluria resolved.

   In search of non-parasitic chyluria case, most of the surgical causes indicated to pyelocaliceal system involved operation (eg. Partial nephrectomy). However, in our case, spinal surgery nearby peritoneum also had risk of chyluria complication. We review past literature of surgery associated iatrogenic chyluria, and make a comparison of disease mechanism hypothesis. Further, the disease course and conservative treatment effect would be discussed in this article as well.