后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿.doc

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1、后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿作者：阚乃尧　陈明　杜耀安　马锦年【摘要】目的探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的手术方法和临床效果。方法对5例患者行经后腹腔镜肾蒂淋巴管结扎术，男2例，女3例；年龄44～70岁；单侧4例，双侧1例，观察手术时间、术中出血量、术后肠道功能恢复和术中、术后并发症及手术效果。结果5例患者均手术成功，手术时间平均126min，术中平均出血100ml,术后肠道功能恢复时间24～48h，术后当天乳糜尿消失，术后平均住院时间7天，出院时尿乳糜试验阴性。随访2～6个月无复发。结论后腹腔镜肾蒂淋巴管结扎

2、术治疗乳糜尿近期疗效较好，具有术中出血少、微创、淋巴管结扎彻底、恢复快、住院时间短等优点，是目前治疗乳糜尿较理想的手术方式。　　【关键词】乳糜尿；腹腔镜术；肾蒂淋巴管结扎　　Experiencesinretroperitoneoscopicligationofrenallymphaticvesselsforthetreatmentofchyluria　　　【Abstract】ObjectiveToevaluatetheoperationtechniqueandtheclinicalefficacyofretroperiton

3、eoscopicligationofrenallymphaticvesselsforthetreatmentofthechyluria.MethodsFivepatientswithchyluria,male2andfemale3,44to70yearsold,underwentretroperitoneoscopicligationofrenallymphaticvessels.Theoperationtime,bloodloss,postoperativeintestinalfunctionrecovery,compli

4、cationsduringoperationandtheoperativeefficacywereobserved.ResultsFivecaseshavebeensuccessfullytreatedwithretroperitoneoscopicmanagement.Theaverageoperationtimewas126minutes,theaveragebloodlosswas100mlandthepostoperativeintestinalfunctionrecoverytime24to48h.Chyluria

5、disappearedonthedayofoperation.Theaveragehospitalstayafteroperationwas7days.Norecurrenceofchyluriawasfoundduringthefollow-upof1-3months.ConclusionRetroperitoneoscopicligationofrenallymphaticvesselsforthetreatmentofchyluriaisaneffectiveandefficientsurgicalprocedurea

6、ndhastheadvantagesoflessbloodloss,minimalinvasion,completelymphaticvesselsligation,shorthospitalstayandrapidrecovery.Sofar,itisanidealsurgicalprocedurefortreatmentofchyluria.　　【Keywords】chyluria；retroperitoneoscopy；ligationofrenallymphaticvessels4　　乳糜尿是泌尿外科常见的疾病之一，

7、是晚期班氏丝虫感染的并发症，临床上最有效的治疗方法是肾蒂淋巴管结扎术。开放性肾蒂淋巴管结扎术腰部切口长，需离断腰部各层肌肉，创伤大，术后卧床和住院时间较长。笔者采用后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿5例，创伤小，恢复快，疗效较好，现报告如下。　　1资料与方法　　1.1一般资料本组5例，男2例，女3例，年龄44～70岁，平均62.6岁。排乳白色尿液史2个月～30年，3例有反复肉眼血尿及乳白或红色胶冻块排出，5例尿乳糜试验均为阳性，脂肪餐后膀胱镜检查4例为单侧，1例为双侧。3例有不同程度营养不良。　　1.2手术方法气管插管全麻。

8、健侧卧位抬高腰桥，常规消毒铺无菌巾。先取腋后线肋缘下约2cm小切口，用大弯血管钳撑开肌层和腰背筋膜，置入自制的扩张气囊，充气500～600ml维持3～5min，形成腹膜后腔隙后置入10mm套管，缝合切口以防漏气。然后插入观察镜，在直视下分别于腋中线髂嵴上1横指、腋前线肋缘下各作10mm切口