机器人辅助后腹腔镜肾蒂淋巴管结扎术与传统后腹腔镜肾蒂淋巴管结扎术治疗难治型乳糜尿的比较(附12例报告)  

Surgical Management of Intractable Chyluria:A Comparision of Renal Pedicle Lymphatic Disconnection via Robot and Retroperitoneoscopy(Report of 12 cases)

作　　者：夏宇[1] 王共先[1] 傅斌[1] 张成[1] 周晓晨[1] 徐祺洋 

机构地区：[1]南昌大学第一附属医院泌尿外科,南昌330006

出　　处：《江西医药》2016年第2期102-105,共4页Jiangxi Medical Journal

摘　　要：目的探讨机器人辅助后腹腔镜肾蒂淋巴管结扎术治疗难治型乳糜尿的手术方法和临床效果,并与普通后腹腔镜肾蒂淋巴管结扎术进行比较。方法回顾分析2015年1月-2015年10月我院连续12例难治型乳糜尿患者的临床治疗效果。其中A组11例患者行后腹腔镜肾蒂淋巴管结扎术,B组1例患者行机器人辅助后腹腔镜肾蒂淋巴管结扎术。对比和评估两种手术方式的手术时间,术中出血量,肠道恢复时间,术后肾旁引流管留置时间,术后住院时间,总住院时间,术中、术后并发症情况和手术效果。结果 12例患者均手术成功且无严重并发症。A、B组手术时间(108.1±20.2min vs 100min),术中出血量(69±39.6ml vs 20ml),肠道恢复时间(2.5±0.6d vs 2d),术后肾旁引流管留置时间(4.1±0.9d vs 4d),术后住院时间(9.1±2.7d vs 7d),总住院时间(13.9±2.7d vs 11d)。两组患者术后均绝对卧床1周,术后复查尿乳糜试验均转阴,无血管损伤等并发症,随访至今均出现肾下垂等相关并发症。结论两种手术方式疗效确切,根据目前统计数据,两组患者手术时间、肠道恢复时间、术后肾旁引流管留置时间、术后住院时间、总住院时间均无明显差异。但由于病例样本数量少、术后随访时间短,目前尚不能完全证实机器人辅助后腹腔镜肾蒂淋巴管结扎术在治疗乳糜尿疾病的优势,仍需进一步临床观察。Objective We compared the clinical effectiveness of renal pedicle lymphatic disconnection for intractable chyluria by the da Vinci Surgical System（Intuitive Surgical, Inc., Sunnyvale, CA） and ordinary retroperitoneoscopy. Methods From January 2015 to October 2015,we retrospectively reviewed the clinical outcomes of 12 patients （12 renal units） with intractable chyluria. Retroperitoneal robot-assisted renal pedicle lymphatic disconnection was performed on 1 patient （Group A,n=1）, and retroperitoneosocopy on 11 patients （Group B, n=1）. Operative time, intraoperative blood loss, postoperative intestinal recovery, postoperative draining time, postoperative hospital stay,total hospital stay,intraoperative and postoperative complications, and operative outcome were evaluated. Results Patients were treated successfully without major complications. Robotic group showed the same advantages as retroperitoneoscopic group in terms of operative time （108.1±20.2min vs lOOmin）,intraoperative blood loss （69±39.6ml vs 20ml）,postoperative intestinal function recovery time （2.5±0.6d vs 2d）, postoperative draining time （4.1 ±0.9d vs 4d）, postoperative hospital stay （9.1±2.7d vs 7d） and total hospital stay （13.9±2.7d vs 11d）. Two groups of patients were absolutely bed 1 week after surgery, in all patients postoperatively testing for urinary chyle was negative,Without vascular injury and other complications. Follow up until now,no recurrence or nephroptosis was diagnosed in any patient. Conclusion Two kinds of operation methods are safe and efficacious,according to the present statistical data,the two groups of patients with Operative time,intraoperative blood loss, postoperative intestinal recovery, postoperative draining time, postoperative hospital stay and total hospital stay were not significantly different. But due to the number of cases is small, and postoperative follow-up time is short, we can not fully confirm the advantage of retroperitoneal robot-assisted renal pedicle lymphati

关 键 词：达芬奇机器人 后腹腔镜 乳糜尿 肾蒂淋巴管结扎术 

分 类 号：R699[医药卫生—泌尿科学]