改良后腹腔镜下肾蒂淋巴管结扎术治疗重度乳糜尿的初步研究

摘要/Abstract

摘要： 目的:观察后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎改良术式治疗重度乳糜尿的临床疗效。方法：回顾分析2013年1月至2021年3月在我院手术治疗的106例重度乳糜尿患者的临床资料。观察组60例行后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎术，对照组46例行后腹腔镜下肾蒂淋巴管结扎+肾固定术，比较两组患者手术时间、术中出血量、术后卧床时间、术后引流管拔除时间、术后住院时间、术后疼痛指数及术后并发症，随访6～24个月。结果：所有手术均顺利完成，无中转开放。观察组患者的手术时间、术中出血量、术后卧床时间、术后住院时间均少于对照组（P＜0.05）；观察组患者拔除引流管时间与对照组比较差异无统计学意义（P＞0.05）。术后第1、3天，观察组患者疼痛视觉模拟（VAS）评分低于对照组（P＜0.05）。术后3个月复查两组患者血红蛋白、血清白蛋白水平，较术前均有好转（P＜0.001），但组间比较差异无统计学意义（P＞0.05）。两组患者均无严重手术并发症，术后3个月尿乳糜试验均为阴性。在术后6～24个月的随访中无一例复发，无肾下垂，所有患者营养状况均明显改善。结论：后腹腔镜下保留肾上极脂肪囊肾蒂淋巴管结扎改良术式在治疗重度乳糜尿与腹腔镜下肾蒂淋巴管结扎+肾固定术疗效无差别，且简便了操作，降低手术操作难度，减少肾脏创伤，加速患者康复。

关键词: font-size:medium, ">保留肾上极脂肪囊；改良后腹腔镜下肾蒂淋巴管结扎术；乳糜尿

Abstract: Objective:To observe the clinical efficacy of modified retroperitoneoscopic renal pedicle lymphatic disconnection sparing the upper pole adipose capsule for treating severe chyluria. Methods: The clinical data of 106 patients with severe chyluria who received surgical treatment in our hospital from January 2013 to March 2021 were retrospectively analyzed. The 60 patients in the observed group received retroperitoneoscopic renal pedicle lymphatic disconnection sparing the upper pole adipose capsule. The 46 patient in the control group received retroperitoneoscopic complete dissection of adipose renal capsule plus ligation of renal pedicle lymphatic vessels. The operation time, intraoperative bleeding, postoperative bed rest time, postoperative drainage tube extraction time, postoperative hospital stay, postoperative pain index and postoperative complications were compared between the two groups. The patients were followed up for 6 to 24 months. Results: There were no cases of open surgery in both groups. The observation group showed statistically significant better results in terms of the operative time, amount of bleeding, bedridden time and the postoperative hospital stay time compared with the control group (P<0.05). The postoperative drainage tube removal time of patients in the observation group had no statistical difference with the control group. The VAS pain score of the observed group at the first and third day after the operation were lower than those of the control group ( P<0.05). Three months after the surgery, the hemoglobin and the serum albumin level of the two groups of patients all improved compared with those before the surgery (P<0.001), and there was no statistical difference on the hemoglobin and serum albumin level between the two groups (P>0.05). There were no serious surgical complications in both groups. The tests for chyluria were all negative in both two groups three months after the operation. There were no cases of recurrence or nephroptosis during follow-up of 6 months to 24 months, and the nutritional status of the patients was obviously improved. Conclusion: The therapeutic effect of modified retroperitoneoscopic renal pedicle lymphatic disconnection sparing the upper pole adipose capsule is definite. It is easy to operate and can reduce kidney trauma and can speed up recovery.

Key words: Sparing the upper pole adipose capsule, Modified retroperitoneoscopic renal pedicle lymphatic disconnection, Chyluria

中图分类号:

孙永明, 蔡龙俊, 王祥宇, 张建军, 方先林, 蔡维奇, 嵇福荣. 改良后腹腔镜下肾蒂淋巴管结扎术治疗重度乳糜尿的初步研究[J]. 中国医药导刊, 2021, 23(12): 887-891.

SUN Yongming, CAI Longjun, WANG Xiangyu, ZHANG Jianjun, FANG Xianlin, CAI Weiqi , JI Furong. Modified Retroperitoneoscopic Renal Pedicle Lymphatic Disconnection for Treating Severe Chyluria[J]. CHINESE JOURNAL OF MEDICINAL GUIDE, 2021, 23(12): 887-891.

参考文献

[1]吴阶平泌尿外科学[M].第2版, 济南: 山东科学技术出版社, 2004: 628-637.
     [2]夏宇,王共先.乳糜性疾病的治疗进展[J]. 国际泌尿系统杂志,2015,35(5):753-757.
     [3]Parthasarathy S,Miller FH,Casalino DD.Chyluria [J]. J Urol, 2012,187(5):1856-1857.
     [4]Guttilla A, Beltrami P, Bettin L, et al. Chyluria: the state of the art[J]. Urologia, 2017,84(2):65-70.
     [5]Purkait B , Garg G , Singh M , et al.Chyluria in pregnancy:etiology, diagnosis, and management perspective[J]. Saudi J Kidney Dis Transpl,2019,30(2):309-314.
     [6]李仁举,冉强. 乳糜尿手术治疗的现状[J].微创泌尿外科杂志,2018,7(2):131-134.
     [7]Harjinder Singh,Anand Singla,Aarushi Jain.Chyluria-a review of literature and a modified sclerotherapy regimen[J]. Turk J Urol,2019,45(Supp l)：S174-S177.
     [8]Breivik EK,Bjornsson GA,Skovlund E.A comparison of pain rating scales by sampling from clinical trial data[J]. Clin J Pain,2000,16(1):22-28.
     [9]Zhang YD, Cao RF, Jiang ZJ. The approach of retroperitoneal laparoscopic partial dissection of adipose renal capsule plus ligation of renal pedicle lymphatic vessels to the treatment of chyluria[J]. Eur Rev Med Pharmacol Sci,2016,20(24):5033-5036.
     [10]杨光斌,周雄,黄永春,等.改良后腹腔镜肾蒂周淋巴管阻断术治疗乳糜尿7例的临床观察[J].中华腔镜泌尿外科杂志(电子版),2019,13(3):175-178.
     [11]刘渠贺,郭志成,陈家存,等.单中心三种后腹腔镜肾蒂淋巴管结扎术的疗效比较[J].国际泌尿系统杂志,2019,39(4):652-655.
     [12]张银高,王行环,曾俊,等.乳糜尿肾周淋巴管分布规律及临床意义[J].中华实验外科杂志,2014,31(7):1597-1600.
     [13]Li X, Ma X, Li H, et al. Retroperitoneal laparoscopic renal pedicle lymphatic disconnection for chyluria[M]. Laparoscopic and Robotic Surgery in Urology. Springer, Singapore, 2020:163-169.
     [14]李仁举,冉强,谢江凌,等.改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的Meta分析[J].微创医学,2018,13(6):735-739.
     [15]Liu B, Zhang J, Li J, et al. Modified retroperitoneoscopic renal pedicle lymphatic disconnection for intractable chyluria[J].Urology,2014,83(5):1195-1198.
     [16]叶雄俊,钟文龙,熊六林,等. 后腹腔镜肾脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿的疗效分析[J].北京大学学报（医学版）,2016,48(4):618-621.
     [17]谢江凌,赖世聪,李仁举,等. 后腹腔镜下肾脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿的疗效分析[J]. 四川医学,2020,41(9):918-921.
     [18]邱祥政,董秉政,范涛,等. 改良的后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿[J]. 东南大学学报（医学版）,2010,29(5):568-569.
     [19]王雷雨,张前进,杨晓伟,等. 经后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿疗效观察[J]. 中国医药导刊,2019,21(5):282-285.
     [20]Abeygunasekera AM , Sutharshan K , Balagobi B. New developments in chyluria after global programs to eliminate lymphatic filariasis[J]. Int J Urol,2017,24(8):582-588.

快速检索引用检索图表检索高级检索