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目的探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的方法和疗效。方法回顾性分析24例行后腹腔镜肾蒂淋巴管结扎术治疗的乳糜尿患者的临床资料。结果 23例经后腹腔途径顺利完成手术,1例因后腹腔空间建立不够满意,且肾周围淋巴组织严重粘连,分离困难,中转开放手术。手术时间60~180 min(平均100 min),术中出血量平均约80 ml,1例因手术中损伤肾静脉出血较多,术后输红细胞悬液2 U,术后住院时间5~9天(平均5.6天),出院时尿液乳糜试验阴性。除术后不同程度短暂肉眼血尿外未出现淋巴漏等术后并发症。随访6~12个月(平均9个月),所有患者均未复发。结论后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿疗效肯定,兼有腔镜手术的微创优点,是治疗乳糜尿理想的方法。
Objective To investigate the method and effect of retroperitoneal laparoscopic lymphatic drainage for the treatment of chyluria. Methods The clinical data of 24 patients with chyluria treated by laparoscopic renal pedicle lymphatic ligation were retrospectively analyzed. Results Twenty - three patients were successfully treated by retroperitoneal approach. One patient was unsatisfied with the establishment of retroperitoneal space. Serious adhesions of lymphoid tissue around the peri - renal were found. The operation time ranged from 60 to 180 minutes (average 100 minutes). The average amount of blood loss during operation was about 80 ml. One case suffered from renal vein hemorrhage during surgery. 2 U of red cell suspension and 5 to 9 days postoperative hospital stay (An average of 5.6 days), discharged urine chylous test negative. In addition to postoperative different degrees of transient gross hematuria without postoperative complications such as lymphatic drainage. All the patients were followed up for 6 ~ 12 months (average 9 months). All the patients did not relapse. Conclusions Retroperitoneal laparoscopic lymphatic drainage of the renal pedicle leads to a positive effect in the treatment of chyluria, and has the advantages of minimally invasive endoscopic surgery. It is an ideal method for the treatment of chyluria.