经后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿

Retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of intractable chyluria

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及疗效。方法应用后腹腔镜肾蒂淋巴管结扎术治疗19例经保守治疗无效的乳糜尿患者,手术步骤主要包括肾周淋巴管剥离、输尿管周围淋巴管的剥离以及肾门淋巴管的剥离。结果本组19例,男13例,女6例,年龄42～71岁,病史2～30年。术前诊断包括尿乳糜试验、静脉肾盂造影、脂肪餐后膀胱镜检查,乳糜尿来源于左侧11例,右侧8例。均采用后腹腔镜途径手术,无中转开放手术,术中出血50～100ml,手术时间90～150min,术后1～2 d肠道功能恢复,2例患者术后出现肉眼血尿,3～5d自行消失,术后住院6～7d。所有患者术后乳糜尿消失,随访3～60个月,无乳糜尿复发。结论腹腔镜肾蒂淋巴管结扎术治疗乳糜尿创伤小,出血少,恢复快,治疗效果满意。

Objective To assess the technique and result of retroperitoneoscopic lymphatic disconnection for the treatment of patients with intractable chyluria.Methods Retroperitoneoscopic lymphatic disconnection was performed to treat 19 patients with intractable chyluria,the technique of laparoscopic management of chyluria consis-ted of nephrolympholysis,ureterolympholysis and hilar lymphatic vessels ligation.Results Our study included 13 males and 6 females from 42 to 71 years old who presented with intractable chyluria of variable duration（2 to 30 years）.Pre-operative diagnosis was based on urine ether test,excretory urogram and cystoscopy after fat diet.Chyluria was from the left side in 11 cases and right side in the other 8 cases.Retroperitoneoscopic renal pedicle lymphatic disconnection was performed successfully in all 19 patients,intraoperative blood losses were minimal（50~100ml）,operative time ranged from 90-150 minutes,postoperative intestinal function recovery time was 24-48 hours,postoperative hospital stays were 6-7days.Chyluria disappeared in all patients without recurrence during a follow up of 3-60 months.Conclusion Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria has the advantages of minimal invasion,less blood loss,rapid recovery and excellent result comparable to open surgery.