摘要
目的 比较腹腔镜引导下建立腹直肌隧道行腹膜透析管置入术与常规腹膜透析管置入术（开放式手术置管）患者的疗效及并发症发生率.方法 选择我院2009年1月～ 2011年12月首次置管并接受腹膜透析治疗的终末期肾病患者60例,将60例患者分为腹腔镜建立腹直肌隧道腹膜透析管置入组（A组）和开放式手术腹膜透析管置入组（B组）,每组各30例,记录两组患者术前的基本情况、术后并发症、生存时间、退出或死亡等结局.结果 平均随访患者12.5个月,A组发生导管机械性功能障碍（堵管）1例（3.33％）,B组5例（16.67％）,其中漂管4例,堵管1例,两组比较差异有统计学意义（P＜0.05）.A组发生导管周围渗漏1例（3.33％）,B组2例（6.67％）.A组术后2周发生感染2例,均为皮下隧道炎；B组术后2周发生感染2例,皮下隧道炎和腹膜炎各1例.结论 腹腔镜建立腹直肌隧道进行腹膜透析置管,管周腹膜透析液渗漏率低,较常规手术导管机械性功能障碍发生率明显下降,尤其对有腹腔手术史的患者.
Objective To compare the effects and complication rate of laparoscopic placement of peritoneal dialysis（PD） catheter in rectus abdominis tunnel with the traditional treatment（open placement of PD catheter insertion）.Methods To retrospectively analyze the clinical data of peritoneal dialysis therapy in 60 patients with end stage renal disease in our department from Jan.2009 to Dec.2011.30 of them underwent laparoscopic placement of PD catheter in rectus abdominis tunnel （group A） and aother 30 patients underwent traditional treatment（group B）.The clinical data including basic situation,postoperative complication,survival time,withdrawal of dialysis,and death were analyzed.Results During the mean follow-up period of 12.5 month,1 case in group A had catheter mechanical dysfunction （plugging） （3.33 ％）,whereas 5 cases occurred in group B （16.67 ％）,including 4 cases with catheter migration,and 1 with plugging.The incidence rate of pericatheter leakage was 3.33％ （1 case） in group A and 6.67％ （2 cases） in group B.In group A,2 patients had infection of subcutaneous tunnel two weeks after operation.In group B,1 had infection of subcutaneous tunnel and the other had peritonitis.Conclusion Compared with the traditional treatment,laparoscopic insertion of peritoneal dialysis catheter in rectus abdominis tunnel can effectively reduce the incidence of catheter mechanical dysfunction,and the dialysate leakage rate was low.It＇s the best choice,particularly for those patients who have received lower abdominal operation previously.
出处
《临床内科杂志》
CAS
2013年第7期460-462,共3页
Journal of Clinical Internal Medicine
关键词
腹腔镜
腹直肌隧道
腹膜透析
导管置入术
Laparoscopy
Rectus sleath tunnel
Peritoneal dialysis
Catheter placement
