目的：评价后腹腔镜肾脂肪囊外肾蒂淋巴管结扎术治疗乳糜尿的临床效果，探讨并发症的处理。方法：2013年8月至2015年6月共收治5例乳糜尿患者，均为女性，年龄26～73岁，病程1～10年。5例患者尿乳糜试验均为阳性。膀胱镜检查均确定为单侧乳糜尿，其中左侧3例，右侧2例。患者均采用改良的后腹腔镜肾蒂淋巴管结扎术进行手术，即在肾脂肪囊外游离肾，不剥离肾周脂肪，重点针对肾蒂血管和输尿管上段的淋巴管进行结扎,观察手术时间、术中出血量、术后肠道功能恢复时间、尿管留置时间、引流管拔除时间和并发症情况，评价手术效果。结果：本组5例手术均顺利完成，手术时间75～170 min，平均（126.0±39.6） min，术中出血量20～60 mL，平均（38.0±16.4） mL，术后肠道功能恢复时间1～3 d，平均（1.9±0.4） d，尿管留置时间1～4 d, 平均（2.1±0.3） d，引流管拔除时间3～15 d, 平均（9.3±1.8） d。术后2例患者出现淋巴漏，无肾血管损伤等并发症发生。术后当日乳糜尿消失，复查尿乳糜试验阴性。随访9～31个月，无1例患者复发。结论：后腹腔镜肾脂肪囊外肾蒂淋巴管结扎术无需剥离肾脂肪囊，不用做肾固定术，可以缩短手术时间，手术效果肯定，术后并发症少。

Objective： To evaluate the clinical effect of retroperitoneoscopic renal pedicle lymphatic disconnection via extra-adipose capsule in the management of chyluria and to discuss the management of its complications. Methods: From August 2013 to June 2008, five patients with chyluria were admitted. All the patients were female,  aged from 26 to 73 years， and disease course from 1 to 10 years．All the five patients had complained of intermittently voiding milky urine with varying degrees of weight loss, and fatigue, of whom two presented with flank pain and one with anemia. Their urine chyle tests were confirmed to be positive. Preoperative cystoscopy found that chyluria was from the left side in 3 cases，and from the right side in 2 cases．Their proteinuria ranged from+to++++. All the cases had been treated with the modified procedure by which lymphatic ligation was performed to hilar vessels and proximalureter via extraadiposecapsule without disconnection of perirenal fat tissues. The operation time, intraoperative blood loss, postoperative intestinal function recovery, catheter time, drainage tube removal time and complications during operation were collected.  Results: All the five cases were performed successfully. The operation time ranged from 75 to 170 minutes, mean (126.0±39.6) minutes, with the intraoperative blood loss 20 to 60 mL, mean (38.0±16.4) mL, and the postoperative intestinal function recovery time 1 to 3 days, mean (1.9±0.4) days. The catheter time was 1 to 4 days, mean (2.1±0.3) days and the drainage tube removal time ranged from 3 to 15 days, mean (9.3±1.8) days. Postoperatively lymphorrhagia was found in two cases. No renal vessels injury occurred during operation. Chyluria of all the patients disappeared on the operation day with negative chyluria test after surgery. Furthermore, urine test revealed that proteinuria was totally negative. No recurrence was detected in our patients in the 9 to 31 months’ follow-up. Conclusion: This modified procedure does not have to disconnect perirenal fat tissues and nephropexy during operation. It was characterized with shorter operation time, definitive effect and fewer complications.