腹腔镜法置管与手术切开法置管对尿毒症腹膜透析患者导管相关并发症及微炎症状态的影响  

Comparison of the effects of laparoscopic catheterization and surgical incision catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis patients

作　　者：吴玮[1] 朱虹[1] 陈佳兮[2] 刘光军 Wu Wei;Zhu Hong;Chen Jiaxi;Liu Guangjun(Department of Nephrology,the First People's Hospital of Jiande,Jiande,Zhejiang 311600,China;Department of Nephrology,the Second Affiliated Hospital of Medical College of Zhejiang University,Hangzhou,Zhejiang 310009,China;Department of Nephrology,the First Affiliated Hospital of Zhejiang University,Hangzhou,Zhejiang 310006,China)

机构地区：[1]建德市第一人民医院肾内科,浙江省311600 [2]浙江大学医学院附属第二医院肾内科,杭州310009 [3]浙江大学附属第一医院肾内科,杭州310006

出　　处：《中国基层医药》2020年第5期572-576,共5页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省杭州市科技发展计划项目(20181228Y251)。

摘　　要：目的探讨腹腔镜法与手术切开法置管对尿毒症腹膜透析(PD)患者导管相关并发症及微炎症状态的影响。方法选择建德市第一人民医院2014年1月至2019年3月行PD治疗的尿毒症患者98例,按置管方法不同分为A组38例、B组60例,A组采用腹腔镜法置管,B组采用手术切开法置管。观察两组手术指标、导管并发症、微炎症状态、早期导管技术生存率。结果A组手术时间[(35.00±3.14)min]较B组[(50.00±5.17)min]短,手术费用[(5800.0±318.9)元]较B组[(3400.0±297.4)元]高,术后视觉模拟评分(VAS)[(2.33±0.31)分]较B组[(3.25±0.49)分]低,两组差异均有统计学意义(t=11.540、9.317、10.328、36.578,均P<0.05)。A组导管相关并发症发生率为10.53%(4/38),B组为28.33%(17/60),两组差异有统计学意义(χ^2=4.383,P<0.05)。两组置管前超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)差异均无统计学意义(均P>0.05),B组置管后hs-CRP、IL-6、TNF-α分别为(12.52±3.75)mg/L、(12.02±3.76)ng/L、(15.92±5.72)ng/L,均高于A组的(9.63±2.36)mg/L、(9.11±3.54)ng/L、(13.41±5.61)ng/L(t=4.244、4.081、4.510,均P<0.05)。随访2个月,A组透析管技术生存率为89.47%(34/38),B组为71.67%(43/60),两组差异有统计学意义(χ^2=4.382,P<0.05)。结论腹腔镜法置管在尿毒症PD患者中的应用效果满意,具有疼痛轻、并发症少等优点,且患者微炎症状态轻,早期导管技术生存率高。Objective To compare the effects of laparoscopic and surgical catheterization on catheter-related complications and microinflammation in uremic peritoneal dialysis(PD)patients.Methods According to different catheterization methods,98 uremic patients who were scheduled to undergo peritoneal dialysis in the First People's Hospital of Jiande from January 2014 to March 2019 were divided into group A(38 cases),group B(60 cases).Laparoscopic catheterization was used in group A,and incision catheterization was used in group B.Surgical parameters,catheter complications,microinflammation and survival rate of early catheterization were observed in the two groups.Results The operation time of group A was(35.00±3.14)min,which was shorter than that of group B[(50.00±5.17)min],and the operation cost of group A was(5800.0±318.9)CNY,which was higher than that of group B[(3400.0±297.4)CNY],and the visual analogue score(VAS)of group A was(2.33±0.31)points,which was lower than that of group B[(3.25±0.49)points],there were statistically significant differences between the two groups(t=11.540,9.317,10.328,36.578,all P<0.05).The incidence of catheter-related complications in group A was 10.53%(4/38),which was significantly lower than 28.33%(17/60)in group B(χ^2=4.383,P<0.05).There were no statistically significant differences in high-sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and tumor necrosis factor-alpha(TNF-alpha)levels between group A and group B before catheterization(all P>0.05).After catheterization,the levels of hs-CRP,IL-6 and TNF-alpha in group B were(12.52±3.75)mg/L,(12.02±3.76)ng/L,(15.92±5.72)ng/L,respectively,which were higher than those in group A[(9.63±2.36)mg/L,(9.11±3.54)ng/L,(13.41±5.61)ng/L](t=4.244,4.081,4.510,all P<0.05).After 2 months of follow-up,the survival rate of dialysis tube technique was 89.47%(34/38)in group A and 71.67%(43/60)in group B,there was statistically significant difference between the two groups(χ^2=4.382,P<0.05).Conclusion Application of laparoscopic catheteriza

关 键 词：尿毒症 腹膜透析 腹腔镜 导管插入术 手术后并发症 C反应蛋白质 白细胞介素6 肿瘤坏死因子α 

分 类 号：R692[医药卫生—泌尿科学]