Department of Urology, the Affiliated Hospital of Xuzhou Medical College, Xuzhou, People's Republic of China.
J Endourol. 2011 Jul;25(7):1161-5. doi: 10.1089/end.2010.0520. Epub 2011 Jun 17.
The retroperitoneoscopic renal pedicle lymphatic disconnection has been performed mainly via a renal adipose (RA) capsule approach. In this study, we reported a novel technique via extra-adipose (EA) capsule approach and compared the two approaches for intractable chyluria.
From December 2002 to March 2008, retroperitoneoscopic renal pedicle lymphatic disconnection was performed on 41 patients with 23 EA and 18 RA. The stripping of hilar vessels and ureterolympholysis were performed in both approaches, while the mobilization of the kidney was only performed in RA. Comparisons of the two approaches were conducted, including mean operative time, intraoperative blood loss, postoperative bed rest, and hospital stay, as well as operative outcome.
Patients were treated successfully without major complications. EA showed the same advantages as RA in terms of intraoperative blood loss (54.9±19.3 mL vs 59.3±26.5 mL, P>0.05), postoperative hospital stay (6.6±1.0 d vs 7.2±0.9 d, P>0.05). Chyluria disappeared in all patients immediately after the operations. EA was significantly superior to RA in operative time (78.9±18.3 min vs 101.8±20.6 min, P<0.05) and the postoperative bed rest time (20.7±1.7 h vs 72.0±0.0 h, P<0.05). No recurrence or nephroptosis was diagnosed in any patient within the follow-up of 21 to 84 months.
Retroperitoneoscopic renal pedicle lymphatic disconnection for chyluria is safe and efficacious. EA offers significantly shorter operative time and earlier return to postoperative ambulation.
经腹膜后腹腔镜肾蒂淋巴管离断术主要通过肾脂肪囊（RA）途径进行。本研究报告了一种通过额外脂肪囊（EA）途径的新方法，并比较了两种方法治疗难治性乳糜尿的效果。
2002 年 12 月至 2008 年 3 月，41 例患者采用经腹膜后腹腔镜肾蒂淋巴管离断术治疗，其中 23 例采用 EA 途径，18 例采用 RA 途径。两种方法均行肾门血管剥离和输尿管淋巴管松解，而仅在 RA 途径中进行肾脏游离。比较两种方法的手术时间、术中出血量、术后卧床时间和住院时间以及手术结果。
患者均成功治愈，无严重并发症。EA 在术中出血量（54.9±19.3 mL 比 59.3±26.5 mL，P>0.05）、术后住院时间（6.6±1.0 d 比 7.2±0.9 d，P>0.05）方面与 RA 具有相同的优势。所有患者术后立即出现乳糜尿消失。EA 在手术时间（78.9±18.3 min 比 101.8±20.6 min，P<0.05）和术后卧床时间（20.7±1.7 h 比 72.0±0.0 h，P<0.05）方面明显优于 RA。在 21 至 84 个月的随访中，没有患者出现复发或肾下垂。
经腹膜后腹腔镜肾蒂淋巴管离断术治疗乳糜尿安全有效。EA 可显著缩短手术时间，并更早恢复术后活动。
