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后腹腔镜肾蒂淋巴管剥离术治疗乳糜尿的经验 被引量:9

Retroperitoneoscopic renal pedicle lymphatic disconnection for management of chyluria
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摘要 目的 总结后腹腔镜肾蒂淋巴管剥离术治疗乳糜尿的经验。方法  2 0 0 1年 11月至 2 0 0 2年 6月共收治乳糜尿病人 6例 ,其中男性 4例 ,女性 2例 ,年龄在 3 4~ 5 2岁之间 (平均 42岁 ) ,病史 3~ 10年。诊断包括尿液乙醚实验 ,静脉肾盂造影、膀胱镜及逆行造影检查。乳糜尿来自左侧肾盂 2例 ,右侧肾盂 4例。后腹腔镜肾蒂淋巴管剥离术主要包括肾周淋巴管剥离 ,肾门淋巴管的剥离以及输尿管周围淋巴管剥离。结果 手术时间在 69~ 12 0min ,平均 95min。术中出血量约 5 0~ 80ml。术后 6例病人乳糜尿立即停止 ,4例 12h内有轻微的肉眼血尿 ,2 4h后消失。 2例穿刺口周围皮下气肿 ,3d后消失。无伤口乳糜漏发生 ,术后 8d出院。随访 1~ 1 5年 ,6例病人体质量增加 1 5~ 3kg ,血色素及血白蛋白平均升高2 0g L及 12g L ,无乳糜尿症状复发。结论 后腹腔镜下肾蒂淋巴管剥离术治疗乳糜尿是一种安全 ,有效的治疗方法 ,具有损伤小 ,病人痛苦少 ,并发症小 ,住院时间短 。 Objective To report our experience in retroperitonescopic renal pedicle lymphatic disconnection for the management of chyluria. Methods Six patients with filarial chyluria were admitted to our hospital between November 2001 and Jun 2002. Of these patients, there were 4 males and 2 females (age range: 34-52 years old, mean age: 42 years old) with a history of chyluria for 3-10 years. Diagnosis of chyluria was made based on urine ether test, cystoscopy, excretory urogram and retrograde pyelography for the presence of chyle and fat globule. Chyluria in the left renal pelvis and in the right renal pelvis was found in 2 cases and 4 cases, respectively. The technique of retroperitoneoscopic management of chyluria consisted of nephrolympholysis, hilar vessel stripping and ureterolympholysis. Results Operative time ranged from 69 min to 120 min (mean time: 95 min). Intraoperative blood losses were about 50-80 ml. Chyluria disappeared in all patients immediately after operation. Mild hematuria was found in 4 cases within 12 h, but disappeared 24 hours later. Subcutaneous emphysema around the ports was found in 2 cases, but was spontaneously absorbed 3 days after the treatment. There was no lymphatic leak through drain. The patients were discharged 4 days after the treatment. All patients gained weight by 1.5-3 kg. Haemoglobin and serum protein increased by 20 g/L and 12 g/L, respectively. No chyluria recurrence was found during a follow up of 1- 1 5 years. Conclusion Retroperitoneoscopic renal pedicle lymphatic disconnection is a safe, effective, and efficient surgical procedure with minimal invasion, less pain, fewer complications, short hospital stay, and rapid recovery for the management of chyluria.
出处 《第三军医大学学报》 CAS CSCD 北大核心 2003年第24期2226-2228,共3页 Journal of Third Military Medical University
关键词 乳糜尿 腹腔镜 淋巴管剥离 chyluria laparoscopy lympholysis
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  • 1刘士怡.泌尿男性生殖系丝虫病[A].见:吴阶平主编.泌尿外科[C].济南:山东科学技术出版社,1993.366-374.

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