后腹腔镜与开放式肾蒂淋巴管结扎术治疗乳糜尿的临床效果比较*

Comparison of safty, complications and efficacy between retroperitoneoscopic renal pedicle lymphatic dissectionwith open surgery for Chyluria*

摘要:

摘要：目的 探讨后腹腔镜肾蒂淋巴管结扎术（RRPLD）与开放式肾蒂淋巴管结扎术（ORPLD）治疗乳糜尿的安全性、并发症及疗效，为临床提供参考。方法 回顾性分析2009年1月－2016年10月贵州省人民医院及德江县人民医院采用肾蒂淋巴管结扎术治疗的36例乳糜尿患者。根据手术方式分为ORPLD组和RRPLD组，分别为14和22例，比较两组的一般资料、手术时间、术中出血量、术后引流管留置时间、术后肠功能恢复时间、术后住院天数及术中并发症；术后随访1～18个月，比较两组的远期治疗效果。结果 两组患者治疗均获成功，术中均未见并发症。两组患者的一般资料比较，差异均无统计学意义（P >0.05）。RRPLD组术中出血量少于ORPLD组，差异有统计学意义（P <0.05）；RRPLD组切口疼痛发生率低于ORPLD组，差异有统计学意义（P <0.05）。两组手术时间、术后肠功能恢复时间、术后引流管留置时间和术后住院天数比较，差异均无统计学意义（P >0.05）。两组复发率比较，差异无统计学意义（P >0.05）。结论 ①RRPLD与ORPLD比较，后腹腔镜术式具有术中出血量少和术后切口疼痛发生率低的优点，是一种治疗乳糜尿更为安全的方法，但两种方法术后复发率没有差异；②RRPLD治疗乳糜尿的疗效肯定，是治疗乳糜尿理想的手术方式。

Abstract:

Abstract: Objective To assess the safty, complications and efficacy of surgical treatment of chyluria with retroperitoneoscopic renal pedicle lymphatic disconnection (RRPLD) and open renal pedicle lymphatic disconnection (ORPLD) and provide a clinical reference. Methods 36 cases of chyluria were treated by renal pedicle lymphatic disconnection from January 2009 to October 2016. According to the surgical method divided into ORPLD group (14 cases) and RRPLD group (22 cases), respectively. The general information, operative time, intraoperative blood loss, postoperative intestinal recovery time, postoperative drainage duration, postoperative hospital stay, intraoperative complications were compared between the two groups. The patients were followed up 1 ~ 18 months, comparison of the long-term treatment of the two groups of patients. Results All the 36 patients were successfully treated with no intraoperative complications. There are no significant differences in the general information (age, male & female, left & right side) of patients between two groups (P > 0.05). The intraoperative blood loss in RRPLD group was significantly less than that in ORPLD group, the difference was statistically significant (P < 0.05). The incidence of incision pain in RRPLD group was lower than that in ORPLD group, the difference was statistically significant (P < 0.05). There was no significant difference between the operative time, postoperative intestinal recovery time, postoperative drainage duration and postoperative hospital stay (P > 0.05). There was no significant difference in recurrence rate between the two groups. Conclusions Retroperitoneoscopic surgery was less intraoperative blood loss, lower postoperative incidence of incision pain and more safe treatment of chyluria between retroperitoneoscopic renal pedicle lymphatic disconnection and open renal pedicle lymphatic disconnection, But the recurrence rate was not significantly reduced compared to open surgery; Retroperitoneoscopic renal pedicle lymphatic disconnection of the treatment of chyluria has definite curative effect, is the ideal treatment of chyluria surgery.