后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿初步体会

目的探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法和临床效果。方法 18例患者均行后腹腔镜肾蒂淋巴管结扎术,观察手术时间、术中出血量、术中术后并发症及手术效果。结果 18例患者均手术成功,手术时间65～125(95±22)min,术中出血量50～120(75±12)mL,术中术后未发生严重并发症。保留内上侧2～3cm粘连,可避免对输尿管过度牵拉,并可免除肾脏缝合固定的操作。16例单侧乳糜尿患者出院时尿液清亮,随访3～26个月无复发,尿乙醚试验为阴性。结论该术式具有微创、出血少、并发症少等特点,淋巴管结扎更加完全,临床效果良好。

Objective To evaluate the method of surgical technique and the clinical efficacy of retro-laparoscopic ligation of renal lymphatic vessels for the treatment of chyluria. Methods 18 case of chyluria underwent retro-laparoscopic ligation of renal lymphatic vessels. The operation time, blood loss, complications during operation and the operative efficacy were observed. Results The average operation time was 65-125（95±22） min, the average blood loss 50-120（75±12）mL. No complications occurred. Difficulty suturing to fix the kidney might be avoided as we keep 2-3cm adhesion at the superior and interior side of the kidney. The urine of 16 patients was clear when the patients were discharged from the hospital. Chyluria disappeared in the 16 cases. No recurrence of chyluria was found during the following up of 3 to 26 months. Conclusion It is an efficient surgical procedure and has the advantages of minimal invasion, less blood loss, less complication and complete lymphatic vessels ligation.