腹腔镜双侧肾蒂淋巴管结扎术治疗乳糜尿.DOCVIP

临床医学论文-腹腔镜双侧肾蒂淋巴管结扎术治疗乳糜尿 ???????? 作者：周晋生，刘仰东，石岩，李香 【摘要】? 目的：探讨经腹腔途径腹腔镜双侧肾蒂淋巴管结扎治疗乳糜尿的手术方法和临床效果。方法：行经腹腹腔镜双侧肾蒂淋巴管结扎术,术中使用超声刀,不放置钛夹,未完全游离肾脏,观察手术时间、术中出血量、术后肠道功能恢复时间、术中术后并发症及手术效果。结果：3例手术均获成功,平均手术时间160min；术中平均出血112ml；术后肠道功能恢复时间平均50h。术后乳糜尿消失,平均住院7d；随访6～12个月无复发。结论：该术式同时结扎双侧淋巴管,具有微创、经济、简便快捷易于定位、出血少，安全可靠,减少并发症发生的特点,近期效果良好。 ??? 【关键词】? 乳糜尿；腹腔镜；肾蒂淋巴管结扎术 ??????? 【Abstract】? Ｏbjective:To evaluate the operation technique and the clinical efficacy of laparoscopic ligation of double renal lymphatic vessels for the treatment of chyluria.Methods:Three patients underwent laparoscopic ligation of double renal lymphatic vessels.The ultracision harmonic scalpel was used instead of titarium.The kidney was not dissodated totally.The operation time,blood loss,postoperative intestinal function recovery,complications during operation and the operative efficacy were observed.Results:All operations were successful.The average operation time was 160min,the average blood loss was 112ml and the postoperative intestinal function recovery time was 50h.Chyluria disappeared on the day of operation.The average hospitalization after operation was 7days.No complications occurred during operation.A followup of 6 to 12 months showed no recurenee.Conclusions:Laparoscopic ligation of doub1e renal lymphatic vessels for the treatment of chyluria is an effective and efficient surgical procedure with the advantages of less blood loss,minimal invasion,short cost and easy operating handle. ??? 【Key words】? Urine;Laparoscopy;Peritoneoscopy ??? 乳糜尿是泌尿外科常见病,临床上治疗方法颇多,但最为有效的是肾蒂淋巴管结扎手术,我们采用经腹腔途径腹腔镜下双侧肾蒂淋巴管结扎术治疗3例双侧乳糜尿患者,近期效果满意,避免了后腹腔镜途径及开放手术的不足,现报道如下。 ??? 1? 资料与方法 ??? 11? 临床资料? 本组3例均为男性,43～52岁,平均497岁。病程13～25年,患者均有消瘦、乏力和不同程度的贫血以及反复发作的乳白色尿液病史,保守治疗效果不佳。均在高脂肪饮食、饮酒或体力劳动后乳糜尿明显加重。其中1例曾接受硝酸银肾盂冲洗治疗,2年后复发；1例曾接受海群生和中药治疗,无明显效果。高脂肪餐后１h行膀胱镜检查,均见到双侧输尿管口喷乳白色尿液,其中1例膀胱内见大量白色块状物。通过输尿管插管收集双侧上尿路尿液做乳糜试验均为阳性。所有病例术前常规行B超及ＩＶＵ检查。未行逆行肾盂造影或淋巴造影检查。 ??? 1.2? 手术方法? 全麻,留置导尿后采用６０°度侧卧位，先行一侧肾蒂淋巴管结扎，一侧完毕后改变体位再行另一侧手术。于脐缘切口穿刺气腹针注入ＣＯ２，建立人工气腹，气压１５mm Hg,并于脐缘、平