腹腔镜肾蒂淋巴管结扎术治疗乳糜尿（附49例报告）

目的探讨腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法、疗效及临床应用价值。方法对49例乳糜尿患者行腹腔镜肾蒂淋巴管结扎术，其中11例行经腹腹腔镜双侧肾蒂淋巴管结扎术，38例行后腹腔镜肾蒂淋巴管结扎术，术前乳糜尿实验均为阳性，采用膀胱镜检查确定乳糜尿的病变侧。焙果49例（60侧）均获得成功，无中转开放手术者。平均手术时间90min（70-120min）；术中平均出血量50mL（20-60mL）；术后平均住院时间6．7d；术后当日乳糜尿消失；术中术后无明显并发症；随访6—15个月无复发。焙论腹腔镜肾蒂淋巴管结扎术具有微创、出血少、恢复快、结扎更彻底及近期疗效好等优点，可替代开放手术成为目前治疗乳糜尿的最佳手术方法。

Experiences in laparoscopic ligation of renal lymphatic vessels for the treatment of chyluria

Objective To evaluate the method of surgical technique, effect and clinical value of the laparoscopic ligation of renal pedicle lymphatic vessels for chyluria. Methods 49 cases of chyluria underwent laparoscopic ligation of renal lymphatic vessels, of whom 11 underwent laparoscopic ligation of double renal lymphatic vessels, and 38 underwent retroperitoneoscopic ligation of renal lymphatic vessels. Diagnosis was based on cystoscopy and urine examination for the presence of chyle and fat globules. Results 49 cases （60 sides） were all successfully treated with laparoscopic management, and none was transferred to open surgery. The average operation time was 90 min （70-- 120 min）, the mean blood loss 50 mL （20-- 60 mL） and the postoperative hospital stay 6. 7 days. Chyluria of all patients disappeared on the operation day postoperatively. No patients had complication during or after operation. No recurrence of chyluria was found during the follow-up of 6-- 15 months. Conclusion Laparoscopic renal pedicle lymphatic ligation for chyluria has the advantages of minimal invasion, less blood loss, rapid recovery, complete lymphatic vessels ligation and a good short-term outcome compared with open surgery. It is becoming the best surgical procedure to replace open surgery for treatment of chyluria.