单通道输尿管镜辅助下腹膜透析管置入术与传统开腹置管临床疗效比较  

Single-tunnel ureteroscope-assisted technique for peritoneal dialysis catheter placement: a comparison with open surgery

作　　者：周军 李伟健 曹月鹏 朱微[2] 郭宏骞[1] 燕翔[1] Zhou Jun;Li Wei jian;Cao Yuepeng;Zhu Wei;Guo Hongqian;Yan Xiang(Department of Urology, Gulou Hospital Affiliated to Medical College of Nanjing University, Nanjing 210008, China;Department of Nephrology, Gulou Hospital Affiliated to Medical College of Nanjing University, Nanjing 210008, China)

机构地区：[1]南京大学医学院附属鼓楼医院泌尿外科,南京210008 [2]南京大学医学院附属鼓楼医院肾脏内科,江苏210008

出　　处：《国际泌尿系统杂志》2019年第3期512-515,共4页International Journal of Urology and Nephrology

基　　金：国家自然科学基金面上项目(81772712);南京市科技发展重点项目(ZKX16037)。

摘　　要：目的探讨单通道输尿管镜(STU)与开腹(OP)腹膜透析管置入术的临床疗效比较。方法回顾分析2013年5月至2017年6月在本院诊断为CKD5期终末期尿毒症患者139例,分STU行腹透管置入(n=76,STU组)和OP行腹透管置入术(n=63,OP组)。观察手术时间、手术切口、住院时间、早期透析导管相关的并发症及导管远期存活情况进行了比较。结果STU组手术切口、手术时间、局麻药剂量、住院天数明显低于与OP组,差异有统计学意义(P<0.050)。STU组早期透析导管障碍率为3.9%(3/76)低于OP组33.3%(21/63),差异有统计学意义(P=0.030),STU组导管移位2.6%(2/76),而OP组导管移位15.9%(10/63),差异有统计学意义(P=0.014)。OP组出现2例切口疝,6例渗漏患者,输尿管镜组未曾出现。平均随访时间2年,STU组和OP组1年后导管存活情况分别是96%、83%,2年后分别是86%、63%,差异有统计学意义(P=0.023)。结论输尿管镜辅助下腹膜透析管置入是一种安全可靠的技术,与传统开腹手术比较,具有手术时间短,术后、导管相关并发症少,远期导管障碍率低的优势,值得推广应用。Objective To compare the treatment of single-tunnel ureteroscope (STU) technique and open surgery (OP) for peritoneal dialysis placement. Methods We retrospectively reviewed 139 consecutive cases of peritoneal catheters insertion, 63 patients for OP and 76 patients for STU group from May 2013 to June 2017. Both methods on their operation-related data, early catheter-related complications, and initial catheter survival were compared. Results The STU group was significantly associated with shorter operation time, hospital stay, smaller incision size, and lesser dose of anesthesia than the OP group(P<0.05). the rate of catheter obstruction in the STU group (33.3%) was significantly lower than that in the OP group (3.9%, P=0.032). Catheter migration occurred at a significantly higher rate in OP group (14.9%), than MPT group (2.6%, P=0.014). Two incisional hernia and six fluid leakage cases occurred in OP group, but none in STU group. After median two years of follow-up, catheter survival rate was significantly higher in STU group than in OP group, with one year survival rates of 96% and 83%, and two year survival rates of 86% and 63%, respectively (P=0.023). Conclusions The ureteroscopy-assisted technique for peritoneal dialysis catheter placement is a safe and reliable. Compared with traditional open surgery, it decreases operation time, postoperative complications, less catheter-related complications, and increases catheter survival. It deserves clinical using regularly.

关 键 词：腹膜透析 导管 输尿管镜检查 外科手术 

分 类 号：R692.5[医药卫生—泌尿科学]