经腹腔途径腹腔镜免钛夹法治疗老年难治性乳糜尿.DOC

经腹路径腹腔镜免钛夹法PK刀肾蒂淋巴管离断术 治疗老年难治性乳糜尿 傅全胜 苏泽轩 卓育敏 暨南大学附属第一医院泌尿外科，广州 510632 摘要:　目的 探讨经腹路径腹腔镜免钛夹法PK刀肾蒂淋巴管离断术治疗老年难治性乳糜尿的临床疗效。方法 回顾性分析2008年10月至2012年8月间共诊治的老年难治性乳糜尿患者17例，平均年龄67岁（62-75岁），其中左侧12例，右侧5例，均采取经腹路径腹腔镜免钛夹法PK刀肾蒂淋巴管离断术治疗。分别观察手术时间、手术出血量、术中和术后并发症、术后住院天数、手术效果等情况。 结果 所有手术均顺利完成，无中转开放，手术时间平均90min。术中出血量平均50ml，平均住院3d，无术后并发症发生。患者术后乳糜尿均消失,平均随访10个月（3～12个月）, 未见复发病例。结论 经腹路径腹腔镜免钛夹法PK刀肾蒂淋巴管离断术具有创伤小、手术快捷、疗效确切、患者术后恢复快等优点, 是治疗老年难治性乳糜尿可靠、安全的腹腔镜手术方式。 关键词:　乳糜尿；经腹腹腔镜；PK刀；肾蒂淋巴管离断术；老年人 Clipless transperitoneal laparoscopic renal pedicle lymphatic disconnection with PK scalpel for intractable chyluria in elderly patients FU Quan-sheng, SU Ze-xuan, ZHUO Yu-min. Department of Urology, The First Affiliated Hospital Of Jinan Unversity, Guangzhou 510632, China Abstract: Objective To evalucate the clinical efficacy of clipless transperitoneal laparoscopic renal pedicle lymphatic disconnection with PK scalpel for intractable chyluria in elderly patients． Methods From Oct.2008 to Aug.2012, 17 elderly patients 62 to 75 years old (mean age 67) with intractable chyluria underwent clipless transperitoneal laparoscopic renal pedicle lymphatic disconnection with PK scalpel. Chyluria was on the left side in 12 cases and on the right side in 5. Operative time, intraoperative blood loss，intraoperative and postoperative complications, postoperative hospital stay and operative outcome were analysed retrospectively. Results Clipless transperitoneal laparoscopic renal pedicle lymphatic disconnection with PK scalpel was performed successfully in all patients without conversion to open surgery. The average operative time was 90 min . The average intraoperative blood loss was 50 ml and average postoperative hospital stay was 3d . No postoperative morbidity occurred . Chyluria disappeared in all patients after operation and did not recur during the followup of 3 to 12 months (mean 10) . Conclusions The key advantage to this technique is its minimally invasive approach, shorten surgical time, decreased postoperati