腹腔镜下腹膜透析置管与传统开腹置管的临床对比研究  

Clinical comparison of peritoneal dialysis catheter placement under laparoscope and by conventional surgical methods

作　　者：敖翔[1] 周巧玲[1] 聂晚年[1] 欧阳燕兰[1] 

机构地区：[1]中南大学湘雅医院肾内科,长沙410008

出　　处：《中国血液净化》2012年第10期544-548,共5页Chinese Journal of Blood Purification

基　　金：2011年百特RRG项目(项目编号:CHN-RENAL-IIS-2012-005)

摘　　要：目的探讨腹腔镜下与传统开腹腹膜透析置管术在近期、远期并发症、手术时间、住院天数、手术费用、住院费用等多方面的临床对比研究。方法选择中南大学湘雅医院自2007年1月至2011年3月对357例诊断为慢性肾脏病(CKD5期)的患者,采取患者自愿选择的方式,分为腹腔镜手术组(A组)141例和常规手术组(B组)216例,A组采用腹腔镜下腹膜透析置管+导管末端不吸收缝线固定,B组采用传统开腹+Seldinger技术腹膜透析置管。比较2组术前及术后血红蛋白(Hb)、血小板(Pt)和血肌酐(Scr)水平、手术时间、近期及远期并发症如腹腔出血、管周渗漏、术中术后疼痛、腹膜炎、导管移位、住院时间、住院费用等方面差异。结果 A、B组既往有腹部手术史患者分别占27.6%、0.9%(X2=59.977,P=0.000)。A、B组术后Scr(875.42±316.34umml/L)(816.25±270.12)分别明显低于术前(911.45±318.59umml/L)(875.42±316.34)(t=-3.189,P=0.003;t=2.007,P=0.049)。A、B组手术时间分别为35.2±16.1min、56.4±22.3min(t=6.224,P=0.014),手术费分别为5478.59±896.91元、3446.26±1381.23元(t=7.675,P=0.000),腹腔出血发生率分别为10.6%、2.8%(t=9.521,P=0.002),术中术后疼痛发生率分别为0.7%、11.1%(X2=14.174,P=0.000),1月内导管移位率分别为0、4.6%(X2=6.716,P=0.010),1月内渗漏发生率分别为12.8%、2.8%(X2=13.572,P=0.000),1月内腹膜炎发生率分别为7.8%、1.4%(X2=9.311,P=0.002),两组均有显著性差异(P<0.05),而A、B组发生腹泻、1年内渗漏发生率、1年内导管移位率,1年内腹膜炎发生率、住院天数、住院总费用、平均日费用等方面均无明显差异(P>0.05)。结论腹膜透析在短期也能改善肾功能。腹腔镜下腹膜透析置管术在慢性肾功能不全既往有手术史、手术时间、疼痛感、近期导管移位发生率等方面较传统开腹腹膜透析置管术有一定优势,但仍存在腹腔出血、渗漏、腹膜炎等并发症的发生。Objective To compare the early and late complications, operation time, hospitalization day, and expenses for surgery and hospitalization between the placement of peritoneal dialysis （PD） catheters under laparoscope and by conventional operation method in patients with chronic kidney disease grade 5 （CKD grade 5）. Methods A total of 357 patients diagnosed as CKD grade 5 were assigned into laparoscopic operation group （group A, n= 141 ） and conventional operation group （group B, n=216） based on patients＇ decision. In group A, the placement of PD catheter was carried out under laparoscope, and the distal end of the PD catheter was fixed by non-absorbable sutures. In group B, this manipulation was performed by using the conventional surgery of Seldinger technique, The differences in hemoglobin, platelet and serum creatinine before and after operation, operation time, early and later complications including bleeding, leakage, pain, peritonitis and catheter displacement, hospitalized day, and expenses for surgery and hospitalization were compared between the two groups. Results Patients having past history of abdominal operation accounted for 27.7% in group A and 0.9% in group B （Z2=59.977, P=-0.000）. Serum creatinine reduced after the operation in both group A （911.45±318.59 μmm/L vs 875.42±316.34μmm/L; t=-3.189, P=0.003） and group B （875.42 ± 316.34 μmm/L vs 816.25±270.12 μmm/L; t=-2.007, P=0.049）. The operation lasted 35.2 ±16.1 min in group A and 56.4 ± 22.3 min in group B （t=6.224, P=0.014）. The operation spent 5478.59 ± 896.91 yuan in group Aand 3446.26 ± 1381.23 yuan in group B （t =7.675, P=0.000）. Bleeding was found in 10.6% and 2.8% （t=9.521, P=0.002）, pain in 0.7% and 11.1% （x2=14.174, P=-0.000）, catheter displacement within one month in 0% and 4.6% （x2=6. 716, P= 0.010）, leakage within one month in 12.8% and 2.8% （x2=13.572, P =0.000）, peritonitis within one month in 7.8% and 1.4% （X2=9.311, P=0.002） of the patients, respectively, in group

关 键 词：腹膜透析 腹膜透析管 腹腔镜 

分 类 号：R459.5[医药卫生—治疗学]