改良后腹腔镜下肾蒂淋巴管结扎术治疗重度乳糜尿的初步研究  

Modified Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Treating Severe Chyluria

作　　者：孙永明 蔡龙俊 王祥宇 张建军 方先林 蔡维奇 嵇福荣 SUN Yongming;CAI Longjun;WANG Xiangyu;ZHANG Jianjun;FANG Xianlin;CAI Weiqi;JI Furong(Suqian Hospital of Nanjing Drum Tower Hospital Group)

机构地区：[1]南京鼓楼医院集团宿迁医院

出　　处：《中国医药导刊》2021年第12期887-891,共5页Chinese Journal of Medicinal Guide

摘　　要：目的:观察后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎改良术式治疗重度乳糜尿的临床疗效。方法:回顾分析2013年1月至2021年3月在我院手术治疗的106例重度乳糜尿患者的临床资料。观察组60例行后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎术,对照组46例行后腹腔镜下肾蒂淋巴管结扎+肾固定术,比较两组患者手术时间、术中出血量、术后卧床时间、术后引流管拔除时间、术后住院时间、术后疼痛指数及术后并发症,随访6~24个月。结果:所有手术均顺利完成,无中转开放。观察组患者的手术时间、术中出血量、术后卧床时间、术后住院时间均少于对照组(P<0.05);观察组患者拔除引流管时间与对照组比较差异无统计学意义(P>0.05)。术后第1、3天,观察组患者疼痛视觉模拟(VAS)评分低于对照组(P<0.05)。术后3个月复查两组患者血红蛋白、血清白蛋白水平,较术前均有好转(P<0.001),但组间比较差异无统计学意义(P>0.05)。两组患者均无严重手术并发症,术后3个月尿乳糜试验均为阴性。在术后6~24个月的随访中无一例复发,无肾下垂,所有患者营养状况均明显改善。结论:后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎改良术式在治疗重度乳糜尿与腹腔镜下肾蒂淋巴管结扎+肾固定术疗效无差别,且简便了操作,降低手术操作难度,减少肾脏创伤,加速患者康复。Objective:To observe the clinical efficacy of modified retroperitoneoscopic renal pedicle lymphatic disconnection sparing the upper pole adipose capsule for treating severe chyluria.Methods:The clinical data of 106 patients with severe chyluria who received surgical treatment in our hospital from January 2013 to March 2021 were retrospectively analyzed.The 60 patients in the observed group received retroperitoneoscopic renal pedicle lymphatic disconnection sparing the upper pole adipose capsule.The 46 patient in the control group received retroperitoneoscopic complete dissection of adipose renal capsule plus ligation of renal pedicle lymphatic vessels.The operation time,intraoperative bleeding,postoperative bed rest time,postoperative drainage tube extraction time,postoperative hospital stay,postoperative pain index and postoperative complications were compared between the two groups.The patients were followed up for 6 to 24 months.Results:There were no cases of open surgery in both groups.The observation group showed statistically significant better results in terms of the operative time,amount of bleeding,bedridden time and the postoperative hospital stay time compared with the control group(P<0.05).The postoperative drainage tube removal time of patients in the observation group had no statistical difference with the control group.The VAS pain score of the observed group at the first and third day after the operation were lower than those of the control group(P<0.05).Three months after the surgery,the hemoglobin and the serum albumin level of the two groups of patients all improved compared with those before the surgery(P<0.001),and there was no statistical difference on the hemoglobin and serum albumin level between the two groups(P>0.05).There were no serious surgical complications in both groups.The tests for chyluria were all negative in both two groups three months after the operation.There were no cases of recurrence or nephroptosis during follow-up of 6 months to 24 months,and the nutritional status of

关 键 词：保留肾上极脂肪囊 改良后腹腔镜下肾蒂淋巴管结扎术 乳糜尿 

分 类 号：R69[医药卫生—泌尿科学]