發(fā)布時間：2018-06-07 01:42

  本文選題：乳糜尿 + 后腹腔鏡��； 參考：《山東醫(yī)藥》2017年42期

【摘要】：目的比較改良后腹腔鏡腎蒂淋巴管結(jié)扎術與傳統(tǒng)腹腔鏡手術治療乳糜尿的臨床療效。方法回顧性分析68例行后腹腔鏡腎蒂淋巴管結(jié)扎術的乳糜尿患者,其中47例行傳統(tǒng)術式(對照組),21例行改良術式(觀察組)。傳統(tǒng)術式在腎包膜外完全剝離整個腎臟后行腎固定術,改良術式為腎門水平以上腎周不作游離、不行腎固定。比較兩組手術時間、出血量等術中情況,以及術后并發(fā)癥、住院時間、隨訪結(jié)果等術后情況。結(jié)果對照組腹腔鏡下成功完成46例,1例中轉(zhuǎn)開放,觀察組21例均順利完成。兩組術中均無大血管及周圍組織損傷,觀察組手術時間較組縮短(P0.05),兩組術中出血量比較無統(tǒng)計學差異。術后對照組2例出現(xiàn)乳糜漏,1例出現(xiàn)尿漏;觀察組1例出現(xiàn)乳糜漏;觀察組術后住院時間較對照組縮短(P0.05)。隨訪42~119個月,兩組術側(cè)尿乳糜定性實驗均為陰性,均無復發(fā)及腎下垂,所有患者營養(yǎng)狀況改善。結(jié)論改良的后腹腔鏡腎蒂淋巴管結(jié)扎術療效與傳統(tǒng)術式相當,其不需游離整個腎臟,不行腎固定術,具有簡化操作、減小創(chuàng)傷、縮短患者手術時間及住院時間等優(yōu)點。
[Abstract]:Objective to compare the clinical effect of modified laparoscopic lymphatic ligation of renal pedicle and traditional laparoscopic surgery in the treatment of chyluria. Methods Sixty-eight patients with chyluria underwent retroperitoneal laparoscopic ligation of renal pedicle lymphatic vessels were retrospectively analyzed, of which 47 cases were treated with traditional operation (control group, 21 cases with modified operation). The traditional operation was performed after the complete exfoliation of the entire kidney outside the renal capsule. The modified procedure was that the kidney above the hilar level was not free and could not be fixed. The operative time, bleeding volume, postoperative complications, hospital stay and follow-up results were compared between the two groups. Results in the control group, 46 cases were successfully turned open under laparoscopy, 21 cases in the observation group were successfully completed. There were no major vascular and peripheral tissue injury in both groups. The operative time in the observation group was shorter than that in the control group (P 0.05). There was no significant difference in the amount of intraoperative bleeding between the two groups. There were 2 cases of chylous leakage and 1 case of urinary leakage in the control group and one case in the observation group, and the postoperative hospitalization time in the observation group was shorter than that in the control group (P 0.05). All the patients were followed up for 42 ~ 119 months. All the patients were negative in the qualitative test of urinary chyme, no recurrence and renal prolapse were found, and the nutritional status of all the patients was improved. Conclusion the effect of modified retroperitoneal laparoscopic renal pedicle lymphatic ligation is similar to that of the traditional operation. It does not need to free the whole kidney and is not suitable for renal fixation. It has the advantages of simplifying operation, reducing trauma, shortening the operation time and hospitalization time of the patients.
【作者單位】： 南方醫(yī)科大學南方醫(yī)院;廣州醫(yī)學院附屬武警醫(yī)院;
【分類號】：R699

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