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目的探讨腹膜后镜下经脂肪囊内与脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿手术方法和临床效果。方法35例患者分为A、B组,分别行腹膜后镜脂肪囊外肾蒂淋巴管结扎术、腹膜后镜下经脂肪囊内肾蒂淋巴管结扎术,比较临床疗效。结果35例患者手术均成功。平均手术时间分别为A组(89.69±42.05)min、B组(116.76±39.80)min;术中出血量平均A组(53.57±38.00)ml、B组(82.86±41.73)ml;A组术后次日下床活动,B组术后卧床7天;术后平均住院A组(6.80±1.08)天,B组(7.57±1.02)天;2组未见明显的外科并发症,出院时尿乳糜试验全部阴性;随访6个月~4.5年无复发。结论腹膜后镜经脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿疗效可靠,与经脂肪囊内途径相比,具有手术时间更短、术后无须长时间卧床等优点。
Objective To investigate the method and clinical effect of peritoneoscopic endoscopic lymphatic ligation in the treatment of chyluria. Methods A total of 35 patients were divided into two groups: group A and group B, which were treated with lymphatic drainage outside the retroperitoneal fat capsule outside the kidneys and ligation of the lymphatic vessels in the kidney via the fat capsule under retroperitoneal resection. The curative effect was compared. Results All the 35 patients were successfully operated. The mean operative time was (89.69 ± 42.05) min in group A and (116.76 ± 39.80) min in group B, respectively. The average amount of blood loss in group A was 53.57 ± 38.00 ml in group A and 82.86 ± 41.73 ml in group B, The patients in Group B were hospitalized for 7 days postoperatively. Average postoperative hospital stay was (6.80 ± 1.08) days in group A and (7.57 ± 1.02) days in group B. No obvious surgical complications were found in group B, All tests were negative; follow-up 6 months to 4.5 years without recurrence. Conclusions The retroperitoneal endoscopic lymphatic drainage outside the fat capsule is effective in treating chyluria, which has the advantages of shorter operation time and no need of prolonged bed rest after operation.