腹腔镜下经后腹腔入路与腹腔入路肾蒂淋巴管结扎术治疗乳糜尿的对照研究

Comparison of retroperitoneal approach and transperitoneal approach laparoscopic of renal pedicle lymphatic disconnection for the treatment of chyluria

目的探讨腹腔镜下经后腹腔入路与腹腔入路肾蒂淋巴管结扎术治疗乳糜尿的优缺点。方法回顾性分析2012年1月至2017年5月郑州大学第一附属医院泌尿外科收治的37例行腹腔镜下肾蒂淋巴管结扎术患者的临床资料。通过经后腹腔入路(22例A组)与腹腔入路(B组)组15例两种途径的手术特点、技术方式、治疗效果方面进行对照研究,比较两组患者的一般资料、手术及随访资料,利用统计学方法对两组数据进行分析。结果两组均无中转开放手术病例。在手术时间方面:A组85.6min,B组103.9min(P<0.05);胃肠功能恢复时间方面:A组2(13)d,B组4(3~6)d(P<0.05),比较以上两组数据差异有统计学意义;术中出血量:A组(45.9±5.2)mL,B组(49.1±5.7)mL(P>0.05);在引流管拔除时间:A组(6.1±0.7)h,B组(5.4±0.9)h(P>0.05);住院天数:A组(7±2)d,B组(6±1)d(P>0.05),以上37例患者中36例获得随访,1例失访,随访时间3~48个月。34例术后未见乳糜尿复发,两组分别有1例复发,症状较轻。两组手术入路方式均取得较好的疗效。结论腹腔镜下经后腹腔入路肾蒂淋巴管结扎术的疗效可观,相比经腹腔入路途径,具有手术时间短,术后胃肠功能恢复快的优势,是目前治疗乳糜尿的首选手术入路方式。

Objective To explore the advantages and disadvantages of laparoscopic retroperitoneal approach and transperitoneal approach of renal pedicle lymphatic disconnection for the treatment of chyluria. Methods We retrospectively analyzed the clinical data of 37 patients undergoing laparoscopic renal pedicle lymphatic disconnection from January 2012 to May 2017. The retroperitoneal approach （A 22cases） and transperitoneal approach（B 15cases） will be control studied on the surgical characteristics,the technical way and the therapeutic,which is comparing the two methods of general information and the operation,followup information of the two group patients and analyzing of the datas with statistical methods.Results There were no cases of open surgery in both groups. In the operative time： group A 85.6 min,group B 103.9 min,（P〈0.05）;Gastrointestinal function recovery time,A group 2 （1-3） d,B group 4 （3-6） d,（P〈0.05）,the differences of the two groups of data were statistically significant;In the area of hemorrhage： group A （45.9±5.2） ml,group B （49.1±5.7） ml,（P〉0.05）;In the drainage tube removal time：group A （6.1±0.7） h,group B （5.4±0.9） h,（P〉0.05）;The number of days of hospitalization： group A （7±2） d,group B （6±1） d,（P〉0.05）,the differences of the two groups of data were not statistically significant. Above of the 37 patients,36 were followed up and 1 lost,the follow up time are 3 to 48 months,34 cases have no recurrence of chyluria. The two groups were 2 cases of recurrence,mild symptoms. Both groups of surgical approach have achieved better results. Conclusions Laparoscopic retroperitoneal approach renal pedicle lymphatic disconnection is the preferred treatment of chyluria surgical approach. Because it has the considerable effect and it has the advantages of short operation time and fast restored gastrointestinal function compared with the transperitoneal approach.