后腹腔镜下单纯肾门旁淋巴管剥脱与肾蒂淋巴管剥脱治疗乳糜尿的比较

Comparison between hilus of kidney lymphatic stripped and lymphatic stripped for chyluria patients under restropertoneoscopy

目的了解后腹腔镜下单纯肾门旁淋巴管剥脱治疗乳糜尿的临床效果,探讨更微创化的后腹腔镜下治疗乳糜尿的手术方法。方法回顾性对比分析两组乳糜尿手术患者32例,A组采用常规后腹腔镜下肾蒂淋巴管剥脱15例,B组采用后腹腔镜下单纯肾门旁淋巴管剥脱术17例,对比两组手术时间、术中出血量、肠功能恢复时间、肾周引流管留置时间、卧床时间和临床疗效等情况。结果两组患者术后尿乳糜试验均转阴,无血管损伤等并发症。A组:手术时间(108.7±11.7)min,术中出血量(69.3±9.6)ml,肠功能恢复时间(2.8±0.7)d,术后肾周引流管留置时间(4.0±0.8)d,术后卧床1周。B组:手术时间(78.9±11.2)min,术中出血量(67.7±9.8)ml,肠功能恢复时间(1.3±0.5)d,术后肾周引流管留置时间(2.2±0.6)d,术后第2天即可下床。手术时间、肠功能恢复时间、术后肾周引流管留置时间等差异有显著性(P<0.05)。结论两种手术方法治疗乳糜尿,疗效确切。后腹腔镜下单纯肾门旁淋巴管剥脱术治疗乳糜尿,手术时间更短,创伤更小,患者下床时间早,对胃肠道影响小,引流管拔除早。

[ Objective ] To evaluate the effect of hilus of kidney lymphatic stripped in chyluria patients with restropertoneoscopy. [Methods] The two groups of chyluria patients were comparatively analyzed. A group： 15 pa- tients were cured with common lymphatic stripped under restropertoneoscopy. B group： 17 cases were treated with hilus of kidney lymphatic stripped under restropertoneoscopy. The operation time, intraopcrative blood loss, intestinal function recovery time, time in bed, negative comersion ratio, drainage tube indwelling time were compared between the two groups. [ Results ] All the patients were healed and there was no complain of vascular and intensive damage. A group operation time （108.7±11.7） min, intraoperative blood loss （69.3±9.6） mL, intestinal function recovery time （2.8±0.7） d, drainage tube indwelling time （4.0±0.8） d, time in bed 7days. B group operation time （78.9±11.2） rain, intraoperative blood loss （67.7±9.8） mL, intestinal function recovery time （1.3±0.5） d, drainage tube indwelling time （2.2±0.6） d, time in bed lday. Operation time, intestinal function recovery time, drainage tube indwelling time were different significantly （P 〈0.05）. [ Conclusion ] The two operation methods have good effect. But hilus of kidney lym- phatic stripped under restropertoneoscopy has the advantage of small operation wound, short operative time, short postoperative in bed, less drainage tube indwelling time and little effect to intestinal function.