摘要
目的评价后腹腔镜技术行肾蒂淋巴管结扎术的临床效果,并与传统开放手术比较.方法确诊乳糜尿的患者53例,年龄30～68岁.病变位于左侧29例,右侧22例,双侧2例.分别经腹膜后腹腔镜(A组,41例,43侧)以及传统开放手术(B组,12例,12侧)行肾蒂淋巴管结扎术,比较两组的术中并发症、手术时间、术中出血量、术后肠道功能恢复时间以及术后住院时间等.结果53例术后均恢复顺利,乳糜尿消失.A组中发生下腔静脉(IVC)损伤1例,于腹腔镜下成功修补;B组中1例肾节段动脉误扎端端吻合成功,1例伤口延迟愈合.随访时间6～84个月,A、B两组各有1例复发.A、B两组手术时间分别为(66.6±20.3)min和(147.5±28.8)min,P＜0.0001;术中出血量分别为(33.7±29.3)ml和(118.3±65.9)ml,P＜0.001;肠道功能恢复时间分别为(26.6±13.8)h和(48.0±25.1)h,P＜0.0001;引流管留置时间分别为(1.7±0.7)d和(2.8±1.7)d,P＜0.001;术后住院时间分别为(3.7±0.9)d和(7.5±1.4)d,P＜0.0001.结论腹膜后腹腔镜技术行肾蒂淋巴管结扎术具有创伤小、恢复快的优点,疗效满意,患者较易接受.
Objective To evaluate the clinical efficacy of renal pedicle lymphatic disconnection for the treatment of chyluria via retroperitoneoscopy and to compare this technique with open surgery. Methods Overall,53 patients (age range,30-68 years) with chyluria (55 renal units;29 cases with lesion on the left side,22,on the right and 2,on both) underwent renal pedicle lymphatic disconnection through retroperitoneoscopy (41 cases,group A) and conventional open surgery (12 cases,group B).The diagnosis of chyluria was confirmed by ether test,and the side of chylous reflux was determined by cystoscopy.The operative time, intraoperative blood loss,postoperative intestinal recovery and hospital stay were compared between the 2 groups.Pre- and post-operative Hb and serum albumin levels were compared during the follow-up. Results All the patients undergoing either retroperitoneoscopy (41 cases,43 units) or open surgery (12 cases) recovered smoothly with chyluria disappearing.In group A,1 case had IVC injury, but had successful repair by laparoscopy.In group B,the renal segmental artery was inadvertently injured in 1 case and anastomosis was performed successfully;and wound healing delay occurred in 1 case.During the follow-up of 6-84 months,1 case had recurrence in each of both groups.In groups A and B,the operative time was ( 66.6± 20.3)min vs (147.5±28.8)min (P<0.0001);intraoperative blood loss was ( 33.7± 29.3)ml vs ( 118.3± 65.9)ml (P<0.001);intestinal recovery time was (26.6±13.8)h vs (48.0±25.1)h ( P< 0.0001); drainage duration was ( 1.7± 0.7)d vs (2.8±1.7)d (P<0.001);hospital stay was ( 3.7± 0.9)d vs ( 7.5± 1.4)d (P<0.0001),respectively. Conclusions Retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria has the advantages of mini-invasion,rapid recovery in comparison with open surgery.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2005年第3期180-183,共4页
Chinese Journal of Urology
基金
卫生部重点临床项目基金资助
