微创医学

目的评价改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效及安全性，为临床治疗乳糜尿提供循证医学证据。方法通过计算机检索PubMed、Cochrane Library、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库和重庆维普等数据库，手工检索《中华泌尿外科杂志》、《中华男科学杂志》、《中国男科学杂志》和《临床泌尿外科杂志》等国内相关杂志，查找比较改良及传统后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的临床对照研究文献，并手检纳入文献的参考文献，检索时限从建库/建刊至2017年12月。按照纳入和排除标准，两位评价者独立进行文献筛查、质量评价和数据提取，采用Revman5.2软件进行Meta分析。结果改良腹腔镜组与传统腔镜组在手术时间（WMD=-32.47，95%CI：-37.12～-27.82，P＜0.001）、术中出血量（WMD=-17.72，95%CI：-28.17～-7.26，P=0.0009）、术后肠道恢复时间（WMD=-26.67，95%CI：-43.57～-9.77，P=0.002）、引流管留置时间（WMD=-1.58，95%CI：-1.91～-1.25，P＜0.001）、术后疼痛评分（WMD=-2.47，95%CI：-2.82～-2.12，P＜0.001）、卧床时间（WMD=-2.04，95%CI：-2.66～-1.43，P＜0.001）、术后住院时间（WMD=-1.71，95%CI：-2.31～-1.12，P＜0.001）、并发症发生率（OR= 0.21，95%CI：0.05～0.86，P=0.03）、复发率（OR=0.16，95%CI：0.03～0.87，P=0.03）等指标比较，差异有统计学意义，改良腹腔镜组明显优于传统腹腔镜组。结论改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效优于传统腹腔镜手术，具有手术时间短、术中出血量少、术后疼痛轻、患者恢复快、并发症少、复发率低等特点，安全性更高。

ObjectiveTo systematically analyze the efficacy and safety of modified retroperitoneal laparoscopic renal pedicle lymphatic ligation for treating chyluria. MethodsThe databases of computer retrieval included PubMed, Web of Science, Cochrane library, CNKI, CBM, Wanfang database and VIP database, etc. The relevant domestic journals of manual retrieval included Chinese Journal of Urology, National Journal of Andrology, Chinese Journal of Andrology and Journal of Clinical Urology. The clinical control trials about the comparison between modified and traditional retroperitoneal laparoscopic renal pedicle lymphatic ligation for treating chyluria were researched. And the references of the studies involved were enrolled by manual retrieval. The time range of retrieval was from establishment of databases/journal to December 2017. Studies screening, estimation of quality and data extraction were conducted by two reviewers independently according to the inclusive and exclusive criteria. The meta analysis was performed by Revman 5.2 software. ResultsThere were statistical differences in the duration of operation（WMD=-32.47，95%CI：-37.12～-27.82, P＜0.001）, intraoperative blood loss（WMD=-17.72，95%CI：-28.17～-7.26, P=0.0009）, duration for postoperative intestinal recovery（WMD=-26.67，95%CI：-43.57～-9.77, P=0.002）, duration for drainage tube indwelling （WMD=-1.58，95%CI：-1.91～-1.25, P＜0.001）, score of postoperative pain（WMD=-2.47, 95%CI：-2.82～-2.12, P＜0.001）, duration for bedridden（WMD=-2.04, 95%CI：-2.66～-1.43, P＜0.001）, postoperative hospital stay（WMD=-1.71, 95%CI：-2.31～-1.12, P＜0.001）, incident rate of complications（OR=0.16，95%CI：0.03～0.87, P=0.03） and recrudescence rate （OR=0.16, 95%CI：0.03～0.87, P=0.03） between the modified laparoscopic group and traditional laparoscopic group. And the modified laparoscopic group was significantly superior to traditional laparoscopic group. ConclusionModified retroperitoneal laparoscopic renal pedicle lymphaticduct ligation obtains a better efficacy for treating chyluria compared to traditional laparoscopic surgery, has the advantages of short operative duration, less intraoperative blood loss, mild postoperative pain, fast postoperative recoolery, less complications and low recrudescence rate, and is safer.