后腹腔镜与开放式肾蒂淋巴管结扎术治疗乳糜尿的临床效果比较

详细信息    查看全文 | 推荐本文 |

英文篇名：Comparison of safty, complications and efficacy between retroperitoneoscopic renal pedicle lymphatic dissection with open surgery for Chyluria 作者：程天飞 ; 饶浩富 ; 游万祥 ; 袁东波 ; 栾博施 ; 苏嘉明 ; 王蔚 ; 朱建国 英文作者：Tian-fei Cheng;Hao-fu Rao;Wan-xiang You;Dong-bo Yuan;Bo-shi Luan;Jia-ming Su;Wei Wang;Jian-guo Zhu;Department of Urology, Liangping District People's Hospital,Chongqing;the First People's Hospital of Xiushui County,Jiujiang, Jiangxi;Department of Urology, Dejiang County People's Hospital of Guizhou;Department of Urology,Guizhou Provincial People's Hospital; 关键词：乳糜尿 ; 后腹腔镜 ; 肾蒂淋巴管结扎术 英文关键词：chyluria;;retroperitoneoscopy;;renal pedicle lymphatic disconnection 中文刊名：ZGNJ 英文刊名：China Journal of Endoscopy 机构：重庆市梁平区人民医院泌尿外科;江西省九江市修水县第一人民医院南院;贵州省德江县人民医院泌尿外科;贵州省人民医院泌尿外科; 出版日期：2018-09-28 15:18 出版单位：中国内镜杂志 年：2019 期：v.25 基金：国家自然科学基金地区项目(No:81660426);; 贵州省卫生计生委科学技术基金项目(No:gzwjkj2016-1-034) 语种：中文; 页：ZGNJ201903001 页数：5 CN：03 ISSN：43-1256/R 分类号：7-11

摘要

目的探讨后腹腔镜肾蒂淋巴管结扎术(RRPLD)与开放式肾蒂淋巴管结扎术(ORPLD)治疗乳糜尿的安全性、并发症及疗效,为临床提供参考。方法回顾性分析2009年1月-2016年10月贵州省人民医院及德江县人民医院采用肾蒂淋巴管结扎术治疗的36例乳糜尿患者。根据手术方式分为ORPLD组和RRPLD组,分别为14和22例,比较两组的一般资料、手术时间、术中出血量、术后引流管留置时间、术后肠功能恢复时间、术后住院天数及术中并发症;术后随访1～18个月,比较两组的远期治疗效果。结果两组患者治疗均获成功,术中均未见并发症。两组患者的一般资料比较,差异均无统计学意义(P>0.05)。RRPLD组术中出血量少于ORPLD组,差异有统计学意义(P <0.05);RRPLD组切口疼痛发生率低于ORPLD组,差异有统计学意义(P <0.05)。两组手术时间、术后肠功能恢复时间、术后引流管留置时间和术后住院天数比较,差异均无统计学意义(P>0.05)。两组复发率比较,差异无统计学意义(P>0.05)。结论①RRPLD与ORPLD比较,后腹腔镜术式具有术中出血量少和术后切口疼痛发生率低的优点,是一种治疗乳糜尿更为安全的方法,但两种方法术后复发率没有差异;②RRPLD治疗乳糜尿的疗效肯定,是治疗乳糜尿理想的手术方式。
        Objective To assess the safty, complications and efficacy of surgical treatment of chyluria with retroperitoneoscopic renal pedicle lymphatic disconnection(RRPLD) and open renal pedicle lymphatic disconnection(ORPLD) and provide a clinical reference. Methods 36 cases of chyluria were treated by renal pedicle lymphatic disconnection from January 2009 to October 2016. According to the surgical method divided into ORPLD group(14 cases) and RRPLD group(22 cases), respectively. The general information, operative time, intraoperative blood loss,postoperative intestinal recovery time, postoperative drainage duration, postoperative hospital stay, intraoperative complications were compared between the two groups. The patients were followed up 1 ～ 18 months, comparison of the long-term treatment of the two groups of patients. Results All the 36 patients were successfully treated with no intraoperative complications. There are no significant differences in the general information(age, male & female,left & right side) of patients between two groups(P > 0.05). The intraoperative blood loss in RRPLD group was significantly less than that in ORPLD group, the difference was statistically significant(P < 0.05). The incidence of incision pain in RRPLD group was lower than that in ORPLD group, the difference was statistically significant(P < 0.05). There was no significant difference between the operative time, postoperative intestinal recovery time,postoperative drainage duration and postoperative hospital stay(P > 0.05). There was no significant difference in recurrence rate between the two groups. Conclusions Retroperitoneoscopic surgery was less intraoperative blood loss, lower postoperative incidence of incision pain and more safe treatment of chyluria between retroperitoneoscopic renal pedicle lymphatic disconnection and open renal pedicle lymphatic disconnection, But the recurrence rate was not significantly reduced compared to open surgery; Retroperitoneoscopic renal pedicle lymphatic disconnection of the treatment of chyluria has definite curative effect, is the ideal treatment of chyluria surgery.

引文

[1]陈孝平.外科学(上、下册)[M].第2版.北京:人民卫生出版社,2010:775.[1]CHEN X P.Surgery[M].2nd ed.Beijing:People’s Medical Publishing House,2010:775.Chinese
    [2]闫泽晨,贾占奎,顾朝辉,等.乳糜尿治疗研究进展[J].医学与哲学,2015,36(3B):63-65.[2]YAN Z C,JIA Z K,GU C H,et al.Study status about the treatment of chyluria[J].Medicine and Philosophy,36(3B):63-65.Chinese
    [3]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.[3]LI R J,RAN Q.Study status about the surgery for chyluria[J].Journal of Minimally Invasive Urology,2018,7(2):131-134.Chinese
    [4]于江,金讯波.乳糜尿:现状及诊治进展[J].泌尿外科杂志:电子版,2018,10(2):55-59.[4]YU J,JIN X B.Chyluria:current situation and advances in diagnosis and treatment[J].Journal of Urology for Clinicians:Electronic Edition,2018,10(2):55-59.Chinese
    [5]闫哲,杨锦建,李松超,等.肾上极筋膜悬吊结扎法与后腹腔镜肾蒂淋巴管结扎术比较研究[J].医学与哲学,2018,39(3B):29-31.[5]YAN Z,YANG J J,LI S C,et al.Comparison between upper pole fascia suspension ligation and retroperitoneoscopic renal pedicle lymphatic dissection[J].Medicine and Philosophy,2018,39(3B):29-31.Chinese
    [6]ZHANG Y,ZENG J,ZHANG K,et al.Surgical management of intractable chyluria:a comparison of retroperitoneoscopy with open surgery[J].Urol Int,2012,89(2):222-226.
    [7]夏宇,傅斌,刘伟鹏,等.腹腔镜与开放性肾蒂淋巴管结扎术疗效比较的Meta分析[J].现代泌尿外科杂志,2016,21(9):681-686.[7]XIA Y,FU B,LIU W P,et al.Laparoscopic renal pedicle lymphatic disconnection versus conventional open surgery:a Metaanalysis[J].Journal of Modern Urology,2016,21(9):681-686.Chinese
    [8]闫泽晨,贾占奎,顾朝辉,等.后腹腔镜肾上极筋膜悬吊结扎法肾蒂淋巴管剥脱术治疗乳糜尿(附16例报告)[J].临床泌尿外科杂志,2013,28(3):39-41.[8]YAN Z C,JIA Z K,GU C H,et al.Retroperitoneal laparoscopic upper pole fascia suspension ligation for the treatment of chyluria(report of 16 cases)[J].Journal of Clinical Urology,2013,28(3):39-41.Chinese
    [9]黄翔,勾艳琴,余波,等.两种肾蒂淋巴管结扎术治疗乳糜尿疗效比较[J].现代医药卫生,2016,32(7):1062-1063.[9]HUANG X,GOU Y Q,YU B,et al.Comparison of the efficacy of two ligation of renal pedicle lymphatic vessels in the treatment of chyluria[J].Journal of Modern Medicine&Health,2016,32(7):1062-1063.Chinese
    [10]温梧.后腹腔镜肾蒂淋巴管结扎术与开放手术治疗乳糜尿的Meta分析[D].湖北:华中科技大学临床医学院,2015.[10]WEN W.Retroperitoneal laparoscopic renal pedicle lymphatic ligation and open surgery for chyluria:Meta analysis[D].Hubei:School of Clinical Medicine,Huazhong University of Science and Technology,2015.Chinese