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目的评价腹膜后腹腔镜与开放肾蒂淋巴管结扎术治疗乳糜尿的临床效果。方法2002年8月至2007年10月采用肾蒂淋巴管结扎术治疗乳糜尿69例71侧,腹膜后腹腔镜组42例,开放手术组27例,比较两术式手术时间、术中出血量,术中、术后并发症发生率、术后住院时间、恢复情况及治疗效果。结果腹膜后腹腔镜组较开放手术组手术时间平均少22min,术中出血量平均少40.5mL,术中并发症发生率高15.09%,术后并发症发生率低73.81%,下床活动早24~57h,肠功能恢复早30~48h,术后住院时间平均少3.6d,恢复正常劳动平均早20d。腹膜后腹腔镜组随访6~24个月无复发,开放手术组随访24~36个月复发2例。术前血清蛋白低于正常者术后恢复正常。结论腹膜后腹腔镜肾蒂淋巴管结扎术在手术时间、术中出血量、术后并发症、术后住院时间、术后康复等方面明显优于开放手术。该方法具有创伤小、术后并发症少、恢复快、疗效肯定等优点,可完全替代开放手术成为治疗乳糜尿较理想的方法。
Objective To evaluate the clinical effect of retroperitoneal laparoscopy and open renal pedicle lymphatic ligation in the treatment of chyluria. Methods From August 2002 to October 2007, 71 patients with 69 cases of chyluria, 42 patients with retroperitoneal laparoscopy and 27 patients with open surgery were treated with renal pedicle lymphatic ligation. The operative time, blood loss , Intraoperative and postoperative complications, postoperative hospital stay, recovery and treatment effect. Results Compared with the open operation group, the mean operative time of retroperitoneal laparoscopic group was less than 22min, the mean amount of bleeding during operation was 40.5mL, the intraoperative complication rate was 15.09%, the postoperative complication rate was 73.81%, and the bed activity was 24 ~ 57h, intestinal function recovery as early as 30 ~ 48h, postoperative hospital stay less an average of 3.6d, return to normal work early 20d. Retroperitoneal laparoscopic follow-up 6 to 24 months without recurrence, open surgery group follow-up 24 to 36 months recurrence in 2 cases. Preoperative serum protein below normal return to normal after surgery. Conclusion Retroperitoneal laparoscopic renal pedicle lymphatic drainage in operation time, intraoperative blood loss, postoperative complications, postoperative hospital stay, postoperative rehabilitation was significantly better than open surgery. The method has the advantages of less trauma, less postoperative complications, quick recovery and definite curative effect, which can completely replace the open operation as the ideal method for treating chyluria.