Clinical analysis of retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria via extra-adipose capsule
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摘要: 目的 评价后腹腔镜肾脂肪囊外途径肾蒂淋巴管结扎术治疗乳糜尿的临床疗效。方法 回顾性分析2012年1月—2018年12月九江市第一人民医院行后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿42例患者的临床资料，其中经后腹腔镜肾脂肪囊外途径18例(A组)，经后腹腔镜肾脂肪囊内途径24例(B组)。结果 A组手术时间、术中出血量、术后放置引流管时间、术后卧床时间及术后住院时间均少于B组，术后镇痛药物使用率低于B组(P < 0.05)。所有患者术后随访8~83个月，A组肾下垂及复发率低于B组，两组比较差异无统计学意义(P>0.05)。结论 后腹腔镜肾脂肪囊外途径肾蒂淋巴管结扎术不需要剥离肾脂肪囊，不用做肾固定，缩短了手术时间，创伤小，恢复快，术后并发症少。该术式是治疗乳糜尿的一种可行而有效的手术方法。Abstract: Objective To evaluate the clinical efficacy of retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) outside adipose capsule for the treatment of chyluria.Methods We retrospectively reviewed the clinical data of 42 patients, including 18 cases (group A) outside adipose capsule and 24 cases (group B) inside adipose capsule for the treatment of chyluria, who underwent RRPLD because of intractable chyluria in the First People's Hospital of Jiujiang from January 2012 to December 2018.Results The operative time, intraoperative bleeding, postoperative drainage tube placement time, postoperative bed rest time and postoperative hospital stay of the group A were shorter than those of the group B, and the use of postoperative analgesic drugs of the group A was less than that of group B (P < 0.05). All patients were followed up from 8 to 83 months after surgery. The renal prolapse and recurrence rates were lower in group A, but the difference was not statistically significant (P > 0.05).Conclusion RRPLD outside adipose capsule does not require complete disconnection of perirenal fat tissue and renal fixation, so it shortens the operative time, minimize trauma, quicken postoperative recovery and reduce complications. This procedure is a feasible and effective surgical method for the treatment of chyluria.
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表 表 1 两组围手术期和随访评价指标
X±S 指标 A组 B组 P值 手术时间/min 90.6±30.8 118.0±39.6 0.002 术中出血量/mL 15.0±6.2 35.0±8.7 0.037 术后镇痛药物使用率/% 3.5±2.2 11.0±4.1 0.029 术后卧床时间/h 23.1±5.2 35.0±9.5 0.037 放置引流管时间/h 42.3±14.5 79.7±41.7 0.001 术后住院时间/d 6.8±1.5 8.9±2.3 0.013 肾下垂率/% 0 8.3 0.601 复发率/% 0 4.2 1.000 
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