后腹腔镜下肾脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿的疗效分析

Clinical Analysis of Retroperitoneoscopic Ligation of Renal Pedicle Lymphatic Vessels Outside Renal Fat Capsule to Treat Chyluria

目的探讨后腹腔镜下肾脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿的疗效和安全性。方法回顾性分析吉首大学附属黔江医院、重庆市黔江区中医院2006年2月至2019年3月128例乳糜尿患者的临床资料。采用后腹腔镜下肾脂肪囊内肾蒂淋巴管结扎术72例(肾脂肪囊内组)、后腹腔镜下肾脂肪囊外肾蒂淋巴管结扎术56例(肾脂肪囊外组),比较两组患者平均手术时间、术后卧床时间、术后住院时间、术后疼痛指数、术后肾下垂发生情况。结果128例手术均顺利完成,肾脂肪囊内组平均手术时间(135.6±11.7)min,术后卧床时间(7.5±0.7)d,术后住院时间(9.3±0.5)d,术后疼痛指数(3.8±0.7)分;肾脂肪囊外组平均手术时间(92.6±7.3)min,术后卧床时间(3.7±0.8)d,术后住院时间(6.8±0.7)d,术后疼痛指数(1.7±0.6)分,两组各项指标比较差异均有统计学意义(P<0.05)。随访6个月,肾脂肪囊内组发生肾下垂2例、肾脂肪囊外组0例,无患者乳糜尿复发。结论后腹腔镜下肾脂肪囊外肾蒂淋巴管结扎术可缩短手术时间、术后卧床时间、术后住院时间,减轻术后疼痛,减少术后肾下垂的发生,值得临床推广应用。

Objective To explore the efficacy and safety of retroperitoneoscopic ligation of renal pedicle lymphatic vessels outside renal fat capsule to treat chyluria.Methods From February 2006 to March 2019,128 cases treated in the affiliated Qianjiang hospital of Jishou university and Qian jiang Chinese medicine hospital were retrospectively analyzed.Renal pedicle lymphatic vessel ligation in renal fat sac under retroperitoneal laparoscopic surgery(intra-adipose capsule group)had 72 cases,renal pedicle lymphatic vessel ligation outside renal fat sac under retroperitoneal laparoscopic surgery(extra-adipose capsule group)had 56 cases.The average operation time,postoperative time in bed,postoperative hospital stays,postoperative pain index,and postoperative renal ptosis were compared.Results 128 cases were all performed successfully.For intra-adipose capsule group,average operation time was(135.6±11.7)min,postoperative bedtime was(7.5±0.7)days,postoperative hospital stay time was(9.3±0.5)days,postoperative pain index was(3.8±0.7)points.For extra-adipose capsule group,average operation time was(92.6±7.3)min,postoperative bedtime was(3.7±0.8)days,postoperative hospital stay time was(6.8±0.7)days,postoperative pain index was(1.7±0.6)points.The differences between two groups were statistically significant(P<0.05).During the 6-months follow-up,there were 2 cases of renal prolapse in intra-adipose capsule group and 0 cases in extra-adipose capsule group with no recurrence of chyluria.Conclusion Retroperitoneoscopic ligation of renal pedicle lymphatic vessels outside the renal fat capsule could shorten operation time,postoperative bedtime and hospital stay,and reduce postoperative pain and occurrence of renal prolapse,which is worthy of clinical application.