CAJ | 학술논문

目的：分析后腹腔镜下改良肾蒂淋巴管结扎术治疗乳糜尿的安全性和疗效。方法回顾性分析2011年10月～2014年10月单一术者所行的后腹腔镜下改良肾蒂淋巴管结扎术治疗乳糜尿53例，分析手术成功率、手术时间、术中出血量、术后引流量、术后拔管时间、术后卧床时间、术后住院天数、并发症发生率等指标。结果53例手术均成功，1(1.88%)例中转开放手术。手术时间中位值为65（51～141） min；出血量中位值32（18～83）ml；术后引流量中位值16（5～127） ml；术后拔管时间中位值2.7（2.0～5.3）d；术后卧床时间中位值1.7（1.2～2.5）d；术后住院天数中位值6.5（5.0～10.3）d；并发症发生率3.77%(2/53)，肾静脉损伤、膈肌损伤各1例。术中、术后均无输血。术后随访3～39个月，平均22个月，乳糜尿消失、无复发，无肾萎缩、肾下垂发生。患者体重增加，营养状况明显改善。结论经后腹腔镜下改良肾蒂淋巴管结扎术治疗乳糜手术时间短，出血少，住院时间短，并发症少，是一种理想的微创治疗方法。
목적：분석후복강경하개량신체림파관결찰술치료유미뇨적안전성화료효。방법회고성분석2011년10월～2014년10월단일술자소행적후복강경하개량신체림파관결찰술치료유미뇨53례，분석수술성공솔、수술시간、술중출혈량、술후인류량、술후발관시간、술후와상시간、술후주원천수、병발증발생솔등지표。결과53례수술균성공，1(1.88%)례중전개방수술。수술시간중위치위65（51～141） min；출혈량중위치32（18～83）ml；술후인류량중위치16（5～127） ml；술후발관시간중위치2.7（2.0～5.3）d；술후와상시간중위치1.7（1.2～2.5）d；술후주원천수중위치6.5（5.0～10.3）d；병발증발생솔3.77%(2/53)，신정맥손상、격기손상각1례。술중、술후균무수혈。술후수방3～39개월，평균22개월，유미뇨소실、무복발，무신위축、신하수발생。환자체중증가，영양상황명현개선。결론경후복강경하개량신체림파관결찰술치료유미수술시간단，출혈소，주원시간단，병발증소，시일충이상적미창치료방법。
Objective To assess the safety and efficacy of modified retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria.Methods 53 cases of chyluria undergoing modiifed retroperitoneoscopic renal pedicle lymphatic disconnection from October 2011 to October 2014 by one surgeon were reviewed retrospectively. Data on the success rate of surgery, the operation time, the blood loss during operation, the drainage time after operation, the bed time after operation, the mean hospitalization time after operation and the complications were analyzed.Results 53 patients were all successfully operated, 1 (1.88%) case was transferred to open surgery. The medium operation time was 65 (51~141) min ,the medium blood loss during operation was32 (18~83) ml, the medium drainage time after operation was 16 (5~127) ml, the medium bed time after operation was 1.7 (1.2~2.5) d, the medium mean hospitalization time after operation was 6.5 (5.0~10.3) d, the complication was 3.77% (2/53), 1 patient had renal vein injury and 1 suffered from diaphragm injury. No blood transfusion occurred. During a follow-up period of 3-39 months (mean 22 months), chyluria disappeared in all patients without recurrence and renal atrophy or nephroptosis wasn’t occurred. all patients gained weight and nutritional condition was improved. Conclusion The advantages of modiifed retroperitoneoscopic renal pedicle lymphatic disconnection for the treatment of chyluria include shorter operation time, the shorter hospitalization time after operation, and less blood loss and less complications. It’s an ideal and minimally invasive surgical procedure for chyluria.