腹膜后腹腔镜与开放肾蒂淋巴管结扎术治疗乳糜尿的疗效分析

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。

Analysis of curative effect of ligating kidney pedicle lymphatic by abdominoscope through retroperitoneum and patefaction operation

Objective To evaluate the clinical effects of ligating kidney pedicle lymphatic by abdominoscope through retroperitoneum and patefaction operation for treating chyluria.Methods From August 2002 to October 2007,there werc 69 cases of ligating kidney pedicle lymphatic:42 cases of abdominoscope through retroperitoneum and 27 cases of patefaction operation.To compare the operation time,operative blood loss,incidence of operative and postoperative complications,length of hospital stay after operation,recovery status and therapeutic effect in two operative methods.Results Compared with the patefaction operation,the average operative time in abdominoscope through retroperitoneum decreased 22 min,the operative blood loss reduced 40.5mL,the incidence of operative complications increased by 15.09%,the incidence of postoperative complications decreased by 73.81%.The out of bed activity,bowel functional recovery time and recovery of normal work in abdominoscope through retroperitoneum were 24-75h,30-48h and 20d respectively earlier than those in the patefaction operation,the length of hospital stay after operation reduced 3.6d.The patients of abdominoscope through retroperitoneum were followed up for 24-36 months without recurrence,and 2 cases of patefaction operation recurred in 24-36 months follow-up.The patients with subnormsl serum albumin restored to normal.Conclusion Ligation of kidney pedicle lymphatic by abdominoscope through retroperitoneum obviously surpasses the patefaction operation in operation time,operative blood loss,postoperative complications,hospital stay length after operation and postoperative rehabilitation,etc.This method has lots of merits:little wound,few postoperative complications,fast recovery and definite curative effect.It will be an ideal method fully substituting the patefaction operation for treating chyluria.