Superficial inguinal lymph node-superficial epigastric vein anastomosis

Chyluria is caused by lymphatic system damage caused by lymphatic reflux, causing increased pressure in the lymphatic vessels, forming a channel between the lymphatics and the urinary tract. The chyle in the lymphatics flows into the urinary tract, and is discharged from the urine. The urine is milky white or cheese-like. It is called chyluria, because chyluria is often accompanied by hematuria, called chyluria. Chyluria can be divided into parasitic and non-parasitic. Parasitic chyluria are often caused by filariasis, and most of the domestic infections are caused by worms. After invading the human body, the worms are parasitic in the deep lymphatic system of the human body (post-peritoneal and pelvic lymphatic system). The mechanical damage and inflammatory damage of the adult worms destroy the lymphatic vessels in the central part of the chyle pool and the lumbar and intestinal total lymph nodes. Wall and valve, these pathological changes affect lymphatic vessel elasticity and lymph flow velocity, loss of effective control of lymphatic pressure and lymphatic centripetal flow, so that lymphatic drainage is slow, retention, intraductal pressure increases, reflux falls, causing lymphatic sputum The kinetic changes, reflux into the renal lymphatics, and the rupture of the kidney near the nipple and the urine mixed with the urine to form chyluria. Because the renal pelvis is the most vulnerable, the renal parenchyma is the least supported by the surrounding tissues, so the renal pelvis is the most common. In addition to silkworms, hydatid, malaria parasites, hookworms, and trichomoniasis can also cause chyluria. Non-parasitic diseases such as tumor compression, tuberculosis, chest and abdomen trauma, surgical injury, congenital or primary lymphoid disease can also cause chyluria. Cystoscopy during the chyluria episode revealed that the chyle was ejected from the ureteral orifice. The diethylether test was performed on both sides of the renal pelvis. The renal pelvic regurgitation was observed by retrograde pyelography. Lymphatic angiography is an important means of diagnosing chyluria. It can show the extent of the lesion and the presence of lymphatic fistula. It is helpful to choose surgical treatment and is helpful for observing the pathological changes of lymph nodes. It is worth mentioning that the results of domestic lymphography showed that the thoracic duct, chylothorax, lumbosacral lymphatic vessels were not obstructed, and the clinical ascending renal pedicle lymphatic ligation did not cause the occurrence or aggravation of contralateral chyluria, negating filariasis chyluria. Lymphatic obstruction theory. Treatment of chyluria, early cases, symptoms are not serious, non-surgical treatment, including bed rest, avoid foods with high fat content, taking traditional Chinese medicine, anti-filaria and anti-inflammatory drugs and 1% to 2% silver nitrate solution Washing, etc., have a certain effect, but easy to relapse. For severe cases, non-surgical treatment can be used for surgical treatment. Common surgical methods include renal pedicle lymphatic ligation, spermatic lymphatic-venous anastomosis, inguinal superficial lymph node-abdominal superficial venous anastomosis. Lymphangiography should be performed before surgery to determine the surgical plan. Inguinal superficial lymph node-abdominal superficial venous anastomosis is also a kind of lymphatic drainage. The theoretical basis is the same as spermatic lymphatic-venous anastomosis. The operation is simple, the wound is small, and it has a certain effect. Treatment of diseases: lymphopathy Indication Indirect inguinal superficial lymph node-abdominal superficial venous anastomosis is suitable for male patients with longer course and repeated chyluria. These patients have obvious lymphatic dilatation and good surgical results. Contraindications Inferior vena cava reflux disease, skin inflammation in the inguinal region, inguinal lymphadenitis, etc. should not be used for this operation. Preoperative preparation Carefully touch the lymph nodes near the great saphenous vein in the ipsilateral groin area of the chyluria and mark them. Surgical procedure 1. Incision: A longitudinal incision is made from the inguinal lymph nodes, and the upper end extends outward and upward. 2. Exposure: cut the skin, subcutaneous tissue to the fossa ovalis, reveal the shallow inguinal lymph nodes, the soft tissue on the surface of the lymph nodes is slightly separated, and the surrounding is not separated, so as not to damage its output and enter the lymphatics. Pay attention to dissect the great saphenous vein and its branches, and find the superficial vein of the abdominal wall in the saphenous vein. This vein travels in a direction equivalent to the inner 1/3 junction of the umbilical to inguinal ligament. Anatomize the branch of the great saphenous vein - the superficial vein of the abdominal wall, and free a section of the vein. It is estimated that there is sufficient length to match the lymph nodes, so that the anastomosis is tension-free, and the proximal end is clamped with a small blood vessel clip, and the distal end is ligated with a silk thread. The superficial vein of the abdominal wall was obliquely cut between the ligation site and the small blood vessel clip. The proximal end of the heart was flushed with heparin saline (heparin 12500 U plus isotonic saline 100 ml). 3. Inguinal lymph node - abdominal wall superficial vein anastomosis: with a sharp knife into the center of the inguinal lymph nodes, deep into the medulla. The lymph node cortex can be cut to form an elliptical wound, and the size of the wound is equivalent to the diameter of the vein. After the lymph nodes were punctured, lymph or bloody lymph fluid was seen to flow out, and the lymph node wounds were washed with heparin saline. Then the superficial vein of the abdominal wall and the lymph node wound were sutured with 7-08-0 non-invasive suture, first anastomosis of the posterior wall, then both sides, the last anterior wall, and the density was not compromised after anastomosis. At the time of anastomosis, the lymph node wound and the venous lumen should be flushed with heparin isotonic saline. After the anastomosis is completed, the venous small blood vessel clamp is opened to check for oozing. 4. Suture the incision layer by layer.