【摘要】 目的探讨改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效。方法回顾性分析南京医科大学第一附属医院2006年2月至2014年1月58例乳糜尿患者的临床资料,其中男38例,女20例。年龄34~75岁,平均年龄(53.4±14.0)岁,平均体质指数(BMI)为18.5kg/m~2。病程为1~7年,临床表现为"牛奶样"乳糜尿。术前采用美国麻醉师协会(ASA)评分均为Ⅱ级。采用改良后腹腔镜下肾蒂周围淋巴管结扎术36例,传统后腹腔镜下肾蒂周围淋巴管结扎术22例,比较两组平均手术时间、术后卧床时间、术后住院时间、术后疼痛指数、术后肾小球滤过率损失、术后血红蛋白及白蛋白改善情况。结果共58例手术均顺利完成。改良组平均手术时间(85.6±21.4)min,术后卧床时间(1.72±0.8)d,术后疼痛指数(1.5±0.6)分,术后住院时间(6.9±1.5)d;传统组平均手术时间(137.4±44.8)min,术后卧床时间(3.41±1.1)d,术后疼痛指数(3.9±1.4)分,术后住院时间(8.7±1.7)d;两组各项指标比较差异均有统计学意义(P均<0.001)。改良组肾小球滤过率损失显著低于传统组[(4.9±2.0)vs.(8.2±2.9)mL/min,P<0.001],两组血红蛋白及白蛋白变化无明显差异(P=0.674)。随访11~130个月,两组均未见复发,无明显并发症及肾下垂发生,两组的治愈率均为100%。结论改良后腹腔镜下肾蒂淋巴管结扎术可缩短手术时间、术后卧床时间、术后住院时间、并减轻患者术后疼痛及减少术后肾功能损失,治疗效果较好。更多还原

【Abstract】 Objective To investigate the efficacy of modified retroperitoneoscopic renal pedicle lymphatic disconnection in the treatment of chyluria.Methods We retrospectively analyzed 58 cases of chyluria treated during Feb.2006 and Jan.2014,including 38 male and 20 female patients,with an average age of(53.4±14.0)(34 to 75)years old and an average body mass index of 18.5 kg/m~2.The course of history ranged from 1 year to 7 years.The clinical manifestation was"milk-like"chyluria.All patients were classified II according to American Society of Anesthesiologists(ASA)score before operation.Modified retroperitoneoscopic renal pedicle lymphatic disconnection was performed in36 patients,and traditional disconnection was performed in the other 22 cases.Relevant perioperative and postoperative parameters were compared between the two groups,including mean operation time,postoperative bed stay,hospital stay,postoperative pain index,glomerular filtration rate loss,and the improvement of hemoglobin and albumin.Results All operations were successful.Better results were shown in the modified group in terms of operation time[(85.6±21.4)vs.(137.4±44.8)min],postoperative bed stay [(1.72±0.8)vs.(3.41±1.1)d],postoperative pain index(1.5±0.6)vs.(3.9±1.4)and postoperative hospital stay[(6.9±1.5)vs.(8.7±1.7)d].There were significant differences between the two groups(all P<0.001).Though there was no difference in hemoglobin and albumin between the two groups(P=0.284 and P=0.674,respectively),there was difference in glomerular filtration rate loss in the modified group and traditional group[(4.9±2.0)vs.(8.2±2.9)mL/min,P<0.001].During the followup of 11 to 130 months,no recurrence,complications or nephroptosis were observed.The cure rate of both groups were 100%.Conclusion Modified retroperitoneoscopic renal pedicle lymphatic disconnection has the advantages of shorter operation time,postoperative bed stay,hospital stay,as well as less postoperative pain and glomerular filtration rate loss.更多还原