后腹腔镜下重复肾上位半肾切除术后乳糜漏的临床分析

目的: 探讨后腹腔镜下重复肾上位半肾切除术后乳糜漏的处理及预防措施。方法: 回顾性分析39例在2004年11月至2011年2月间行后腹腔镜下重复肾上位半肾切除术后发生乳糜漏的5例临床资料。其中男4例,女1例,平均42(32~60)岁,对其行保守治疗并观察疗效。结果: 5例术后乳糜漏持续时间5~31 d,且前4例均发生在开展该术式的前2年。乳糜漏均发生于左重复肾上位半肾切除术后;均通过保守治疗成功。结论: 后腹腔镜下重复肾上位半肾切除术后可发生乳糜漏,且以左侧多见;术中手术层面清晰、创面止血确切、并以钛夹或hemolock夹闭损伤的主要淋巴管、在肾蒂上方置泰绫、必要时喷生物蛋白胶等,可有效预防乳糜漏的发生;保守治疗可获满意疗效。

Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney

Objective:To discuss management of chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney.Methods:Between November 2004 and February 2011,39 patients underwent retroperitoneoscopic upper-pole heminephrectomy for duplex kidney,of these 5 patients had chylous leakage.The ages of the patients ranged from 32 to 60 years(mean 42).All the patients were treated conservatively,and the therapeutic effects were observed.Results:Delayed chylous leakage in 5 patients occurred 5–31 days after surgery,and leakage occurred in 4 of the same 5 patients during the first 2 post-operative years.Chylous leakage after retroperitoneoscopic upper-pole heminephrectomy for duplex kidney preferentially occurred at the left side of duplex kidney.All the patients healed under conservative treatment.Conclusion:Chylous leakage typically occurs after left retroperitoneoscopic upper-pole heminephrectomy for duplex kidney,and can be prevented by improving surgical technique;it can be completely relieved by conservative management with satisfactory results.