title: [Application of lymphography in the location and treatment decision of chyle leakage: an analysis of 177 cases].
abstract: OBJECTIVE
  To identify the value of lymphography in the location and treatment decision of chyle leakage.
  
  
  METHODS
  The clinic data of 177 patients suffered from chyle leakage admitted in 6 medical centers in Shanghai from February 1998 to December 2014 was analyzed retrospectively. There were 94 male and 83 female patients aging from 9 to 84 years with a mean of 49 years, including 128 cases of chyluria, 34 cases of primary chylothorax and 15 cases of other chyle leakage. All patients had failed to conservative treatment more than 2 weeks. Pedal lymphography was performed in every patient to investigate the site and range of chyle leakage. Effect of surgical or conservative management was compared according to the different results of lymphography.
  
  
  RESULTS
  No serious complication was noticed. For all 177 patients, lymphography showed localized lymphatic diseases in 148 cases (83.6%), including 125 cases of lymphatic renal pelvic leaks, 14 cases of unilateral identified leak within thorax and 9 cases of chyle leakage in neck, heart, abdomen or scrotum. Among these patients, surgical treatment cured 129 and improved 3 patients but failed in 2 patients, while the remaining 14 cases had their leaks decreased after lymphography and cured by conservative management. For those 15 patients having disseminated lymphatic diseases or 14 with no abnormality under lymphography, surgery only cured 2 and improved 1 patient but failed in 8 patients (with 3 death), whereas continuous conservative treatment cured 11 patients, improved 5 patients but only failed in 2 patients (with one death). For localized leakage, surgical treatment showed better efficacy (98.5% vs. 3/11), whereas conservative treatment had significantly higher successful rate than surgical interventions in patients with disseminated lymphatic diseases or no abnormality under lymphography (16/18 vs. 3/11).
  
  
  CONCLUSIONS
  Lymphography could identify the location and range of complicate chyle leakage failed to primary conservative management. Patients with disseminated lymphatic diseases or no abnormality under lymphography would be better managed by continuous non-operative treatment partly due to therapeutic effect of lymphography, while surgical intervention could be a good option for patients having localized lymphatic etiology.
authors.affiliation: Department of Urology, Shanghai Punan Hospital, Shanghai 200125, China.
authors.forename: Dingyi
authors.initials: D
authors.lastname: Liu
authors.forename: Weimu
authors.initials: W
authors.lastname: Xia
authors.forename: Qi
authors.initials: Q
authors.lastname: Tang
authors.forename: Jian
authors.initials: J
authors.lastname: Wang
authors.forename: Mingwei
authors.initials: M
authors.lastname: Wang
authors.forename: Chongyu
authors.initials: C
authors.lastname: Zhang
authors.forename: Wenlong
authors.initials: W
authors.lastname: Zhou
authors.forename: Jianxin
authors.initials: J
authors.lastname: Shi
authors.forename: Qianjun
authors.initials: Q
authors.lastname: Zhou
authors.forename: Heng
authors.initials: H
authors.lastname: Zhang
authors.forename: Yewei
authors.initials: Y
authors.lastname: Xie
authors.forename: Yuan
authors.initials: Y
authors.lastname: Shao
mesh_terms: D034841:Abdominal Cavity; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002913:Chyle; D002916:Chylothorax / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006321:Heart; D006801:Humans; D007682:Kidney Pelvis; D008206:Lymphatic Diseases; D008220:Lymphography; D008297:Male; D008875:Middle Aged; D009333:Neck; D012189:Retrospective Studies; D012611:Scrotum; D055815:Young Adult