超声引导下微穿刺系统置入腹膜透析导管的临床应用  

Clinical application of peritoneal dialysis catheter implantation by ultrasound-guided micro-puncture system

作　　者：郭姗姗 付纲[1] GUO Shan-shan;FU Gang(Department of Nephrology,Beijing Haidian Hospital,Beijing 100080,China)

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)肾内科,北京100080

出　　处：《中国血液净化》2020年第4期274-277,共4页Chinese Journal of Blood Purification

摘　　要：目的探索并完善更加简便、安全穿刺置入腹膜透析管的方法。方法将2018年1月~2019年4月就诊北京市海淀医院需行腹膜透析置管的患者随机分为穿刺组和外科手术切开组,每组各15例,分析总结手术方法、效果及术后并发症。结果 2组患者在半年的观察期间均没有因为并发症退出腹膜透析,在术中明显出血、术中脏器损伤、术后3日内血性腹水2组间比较无统计学差异(χ^2值分别为0.307,0.000,0.000;P值分别为0.543,1.000,1.000);2组间在术后1个月内出现渗漏和导管移位、腹膜透析相关性腹膜炎、外出口感染及6个月内外口感染无显著差异(χ^2值分别为1.034,2.143,1.034,0.000;P值分别为0.309,0.143,0.309,1.000);仅在手术时间、手术切口长度及术后排气时间存在统计学差异(χ^2值分别为-5.849,-9.102,13.630;P值分别为<0.001,<0.001,0.002)。结论超声引导下微穿刺系统置入腹膜透析导管简便、安全,与传统外科手术置管方法相比手术并发症及导管生存率相似。Objective To explore an improved,convenient and safe method to implant peritoneal dialysis(PD)catheters.Methods The patients who required to implant catheters for PD and were treated in Beijing Haidian Hospital in the period from January 2018 to April 2019 were randomly divided into two groups:puncture group(n=15)and surgical incision group(n=15).Their surgical method,effects and postoperative complications were analyzed.Results There were no PD patients in the two groups changed to other dialysis methods because of complications in the 6-month observation period.There were no differences in intraoperation bleeding,organ injury due to operation and bloody ascites within 3 days after the operation between the two groups(χ^2=0.307,0.000 and 0.000 respectively;P=0.543,1.000 and 1.000 respectively).There were also no differences in catheter leakage and displacement,peritoneal dialysis-associated peritonitis,external exit infection within one month,and external exit infection within 6 months between the two groups(χ^2=1.034,2.143,1.034 and 0.000 respectively;P=0.309,0.143,0.309 and 1.000 respectively).However,operation time,incision length,and intestinal exhaust time after operation were statistically different between the two groups(χ^2=-5.849,-9.102 and 13.630 respectively;P<0.001,<0.001 and 0.002 respectively).Conclusion Ultrasound-guided micropuncture system is simple and safe for implantation of PD catheters,with similar rates of operative complications and catheter survival compared to the traditional surgical method.

关 键 词：腹膜透析 经皮穿刺 超声引导 微穿刺针 

分 类 号：R459.5[医药卫生—治疗学]