后腹腔镜肾蒂淋巴管结扎术治疗寄生虫性乳糜尿22例报告

目的探讨后腹腔镜肾蒂淋巴管结扎术治疗寄生虫性乳糜尿的疗效及应用价值。 方法回顾性分析2012年1月至2016年12月我科收治的22例寄生虫性乳糜尿患者临床资料,其中男9例,女13例,年龄52~72岁（平均60.5岁）,病程1~30年（平均5.6年）。所有患者确诊为单侧乳糜尿,采用后腹腔镜肾蒂淋巴管结扎术治疗,术中输尿管上段及肾蒂血管"骨骼化"后对周围淋巴管进行充分结扎。分析手术时间、出血量、术后肠功能恢复时间、住院时间及随访手术疗效指标。 结果22例手术均取得成功,无中转开放,手术时间75~140 min（平均95 min）,出血量10~300（中位出血量65 ml）,术后肠功能恢复时间10~24 h（平均16.5 h）,术后住院时间4~9 d（平均5.5 d）;术中1例肾静脉轻度损伤、2例后腹膜损伤,均于腔镜下修补成功。2例发生皮下气肿,保守治疗好转。所有患者术后随访1~4年（平均2.3年）均无复发。 结论后腹腔镜肾蒂淋巴管结扎术治疗寄生性乳糜尿疗效满意,是具有一定后腹腔镜操作经验的基层医院较理想的手术方式。

Renal pedicle lymphatic ligation for parasitic chyluria via retroperitoneal laparoscope: report of 22 cases

ObjectiveTo investigate the clinical efficacy and application value of renal pedicle lymphatic disconnection via retroperitoneal laparoscope in the treatment of parasitic chyluria. MethodsClinical data of 22 patients diagnosed with parasitic chyluria admitted to our department from January 2012 to December 2016 were retrospectively analyzed, including 9 male and 13 female, aged 52-72 years (60.5 years on average), the course of disease ranging from 1 to 30 years (5.6 years on average). All patients were diagnosed with unilateral chyluria and treated with renal pedicle lymphatic disconnection under retroperitoneal laparoscope. Intraoperatively, the surrounding lymphatic vessels were fully ligated after the upper segment of the ureter and renal pedicle vessels were skeletonized. The operation time, intraoperative blood loss, the recovery time of postoperative intestinal function, the length of hospital stay and surgical efficacy during follow-up were analyzed. ResultsAll 22 cases successfully completed the surgery. No conversion to open surgery was required. The operation time was 75-140 min (95 min on average). Intraoperative blood loss was 10-300 ml with a median volume of 65 ml. The recovery time of postoperative intestinal function was ranged from 10 to 24 h (16.5 h on average). The length of postoperative hospital stay was 4-9 d, 5.5 d on average. Intraoperatively, 1 patient presented with slight renal vein injury and 2 cases of retroperitoneal injury, which were successfully repaired under laparoscope. Two patients developed subcutaneous emphysema, which was mitigated by conservative treatment. All patients were followed up for 1 to 4 years, 2.3 years on average. No case recurred. ConclusionRenal pedicle lymphatic disconnection under retroperitoneal laparoscope yields high efficacy in the treatment of parasitic chyluria. It is an ideal surgical approach in primary hospitals in which certain experience has been accumulated in retroperitoneal laparoscopic operation.