后腹腔镜肾蒂淋巴管结扎术并发症的病因分析及处理

The causes and measurement of complications of retroperitoneoscopic ligation of renal lymphatic vessel

目的:探讨后腹腔镜肾蒂淋巴管结扎术并发症的原因和防治措施,以期提高这类手术的安全性。方法:回顾分析我院2002年8月～2007年5月采用后腹腔镜肾蒂淋巴管结扎术治疗57例乳糜尿患者的临床资料。结果:57例患者中有3例(5.3%)出现术中并发症,包括血管损伤,误夹肾血管和严重高碳酸血症各1例,均在术中给予相应处理,未中转开放。术后并发症包括乳糜漏2例,充分引流后自愈。术后复发1例,再次手术治愈。结论:为预防和减少并发症,要充分认识后腹腔解剖结构,尤其是要注意血管走向及其变异情况;精细操作,结扎淋巴管彻底,熟练掌握后腹腔镜肾蒂淋巴管结扎术操作技术。

To investigate the causes and measurement of complications of retroperitoneoscopic renal pedicle lymphatic disconnection. Methods： Retrospective analysis of retroperitoneoscopic operations for chyluria in 57 patients was performed. Results： Total 57 operati0ns were performed in 57 patients including 54 cases with chyluria on one side and 3 bilateral, lntraoperative complications were observed in 3 patients （5.3% ）, including gonad vein rupture in 1 case, clamping of renal atrtery with a clip by mistake in 1 case and serious hypercarbia and acidosis in 1. All the above complications were treated smoothly during operation and no conversion was needed. Postoperative complications included lymphatic leak in 2 cases, which were self-cured after drainage for 3--5 days, and recurrence in 1 case who was cured by re-operation. Conclusions：Complications of retroperitoneoscopic renal pedicle lymphatic disconnection should be avoided by improving surgeons＇ expertise and experience. Furthermore, it was also very important to recognize retroperitoneal space and the organs structure under laparoscopic vision, especially the anatomical relation of renal vessels and their branches, and possibility of variation of renal vessels.