传统腹腔镜与改良后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿效果比较

发布时间：2018-06-07 01:42

本文选题：乳糜尿 + 后腹腔镜　；参考：《山东医药》2017年42期

【摘要】：目的比较改良后腹腔镜肾蒂淋巴管结扎术与传统腹腔镜手术治疗乳糜尿的临床疗效。方法回顾性分析68例行后腹腔镜肾蒂淋巴管结扎术的乳糜尿患者,其中47例行传统术式(对照组),21例行改良术式(观察组)。传统术式在肾包膜外完全剥离整个肾脏后行肾固定术,改良术式为肾门水平以上肾周不作游离、不行肾固定。比较两组手术时间、出血量等术中情况,以及术后并发症、住院时间、随访结果等术后情况。结果对照组腹腔镜下成功完成46例,1例中转开放,观察组21例均顺利完成。两组术中均无大血管及周围组织损伤,观察组手术时间较组缩短(P0.05),两组术中出血量比较无统计学差异。术后对照组2例出现乳糜漏,1例出现尿漏;观察组1例出现乳糜漏;观察组术后住院时间较对照组缩短(P0.05)。随访42~119个月,两组术侧尿乳糜定性实验均为阴性,均无复发及肾下垂,所有患者营养状况改善。结论改良的后腹腔镜肾蒂淋巴管结扎术疗效与传统术式相当,其不需游离整个肾脏,不行肾固定术,具有简化操作、减小创伤、缩短患者手术时间及住院时间等优点。
[Abstract]:Objective to compare the clinical effect of modified laparoscopic lymphatic ligation of renal pedicle and traditional laparoscopic surgery in the treatment of chyluria. Methods Sixty-eight patients with chyluria underwent retroperitoneal laparoscopic ligation of renal pedicle lymphatic vessels were retrospectively analyzed, of which 47 cases were treated with traditional operation (control group, 21 cases with modified operation). The traditional operation was performed after the complete exfoliation of the entire kidney outside the renal capsule. The modified procedure was that the kidney above the hilar level was not free and could not be fixed. The operative time, bleeding volume, postoperative complications, hospital stay and follow-up results were compared between the two groups. Results in the control group, 46 cases were successfully turned open under laparoscopy, 21 cases in the observation group were successfully completed. There were no major vascular and peripheral tissue injury in both groups. The operative time in the observation group was shorter than that in the control group (P 0.05). There was no significant difference in the amount of intraoperative bleeding between the two groups. There were 2 cases of chylous leakage and 1 case of urinary leakage in the control group and one case in the observation group, and the postoperative hospitalization time in the observation group was shorter than that in the control group (P 0.05). All the patients were followed up for 42 ~ 119 months. All the patients were negative in the qualitative test of urinary chyme, no recurrence and renal prolapse were found, and the nutritional status of all the patients was improved. Conclusion the effect of modified retroperitoneal laparoscopic renal pedicle lymphatic ligation is similar to that of the traditional operation. It does not need to free the whole kidney and is not suitable for renal fixation. It has the advantages of simplifying operation, reducing trauma, shortening the operation time and hospitalization time of the patients.
【作者单位】：南方医科大学南方医院;广州医学院附属武警医院;
【分类号】：R699

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