不同腹膜透析置管术对腹部手术或感染史慢性肾衰竭患者的疗效分析  

Analysis of efficacy of different peritoneal dialysis catheterizations in patients with chronic renal failure and history of abdominal surgery or infection

作　　者：杨文[1] 沈建伟 钱宝鑫 薛茵茵 郑羽飘 师军华 YANG Wen;SHEN Jianwei;QIAN Baoxin;XUE Yinyin;ZHENG Yupiao;SHI Junhua(Department of Nephrology,Binhai Hospital of Peking University/Tianjin Fifth Central Hospital,Tianjin 300450,China;Department of Hepatology and Gastroenterology,Tianjin Municipal Third Central Hospital,Tianjin 300170,China;College of Pharmacy,Nankai University,Tianjin 300073,China;Third Central Clinical College of Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]北京大学滨海医院/天津市第五中心医院肾内科,天津300450 [2]天津市第三中心医院消化肝病科,天津300170 [3]南开大学药学院,天津300073 [4]天津医科大学三中心临床学院,天津300070

出　　处：《重庆医学》2019年第22期3866-3869,3873,共5页Chongqing medicine

摘　　要：目的比较开腹和腹腔镜两种方式行腹膜透析置管术对既往有腹部手术史、腹腔感染史等特殊情况的慢性肾脏病5期(CKD5期)患者的有效性及安全性,为临床术式选择提供依据。方法选择天津市第五中心医院符合CKD5期并既往有腹部手术史、腹腔感染史等腹腔特殊情况的慢性肾衰竭患者33例,根据患者意愿确定手术方式,13例行开腹腹膜透析置管术(A组),20例行腹腔镜下腹膜透析置管术(B组),比较两组患者手术时间、术中出血量、术后24 h疼痛程度及术后导管相关并发症的发生率和肾病相关临床指标等差异,随访12个月。结果B组在手术时间、术中出血量、术后24 h疼痛程度方面均低于A组,组间差异有统计学意义(P<0.01);B组术后1年内导管引流不畅率及导管移位率均低于A组,差异有统计学意义(P<0.05);其他导管相关并发症及术后6个月/12个月肾病相关临床指标,两组差异无统计学意义(P>0.05)。结论在既往有腹部手术史或腹腔感染史等腹部特殊情况的患者中,腹腔镜置管术可缩减手术时间、减少术中出血、减轻术后疼痛等级,降低导管引流不畅及导管移位的发生率,是对于有腹部特殊情况患者更推荐的术式。Objective To compare the effectiveness and safety of the two modes of laparotomy and laparoscopy for conducting peritoneal dialysis catheterization in the patients with the stage 5 of chronic kidney disease(CKD stage 5)and special situation such as abdominal surgery and intra-abdominal infection so as to provide the basis for clinical operation mode selection.Methods Thirty-three cases of chronic kidney failure with the special abdominal conditions such as past abdominal surgery history or intra-abdominal infection in the Tianjin Fifth Central Hospital were selected.According to the wishes of the patients,the operation mode was determined.Thirteen cases performed the laparotomic dialysis catheterization(group A),and 20 cases conducted the laparoscopic dialysis catheterization(group B).The differences in the operation time,intra-operative blood loss volume,postoperative 24 h pain degree,occurrence rate of postoperative catheter related complications and nephropathy related clinical indicators were compared between the two groups and conducted the 12-months follow up.Results The operation time,intra-operative bleeding volume and postoperative 24 h pain degree in the group B were lower than those in the group A,the differences between the groups were statistically significant(P<0.01).The catheter drainage unobstructed rate and the catheter displacement rate within 1 year in the group B were lower than those in the A group,and the differences were statistically significant(P<0.05);the other catheter related complications and the nephritic related clinical indexes in postoperative 6/12 months showed no statistically significant differences between the two groups(P>0.05).Conclusion In the patients with the special conditions such as past abdominal surgery history or intra-abdominal infection,the laparoscopic catheterization can reduce the operation time,decrease intraoperative bleeding,alleviate postoperative pain level and reduce the incidence rate of catheter obstruction and catheter displacement,which is a more reco

关 键 词：腹膜透析 腹腔镜 慢性肾衰竭 腹部手术史 

分 类 号：R419.5[医药卫生—临床医学]