腹膜透析在有腹部手术史的终末期肾病患者中的应用  

Application of peritoneal dialysis in patients with end-stage renal disease and a history of abdominal surgery

作　　者：何青莲[1] 程小云[1] 刘攀 徐尔侃[2] He Qinglian;Cheng Xiaoyun;Liu Pan;Xu Erkan(Nephrology Department,Chengdu Second People's Hospital,Chengdu,Sichuan 610017,China;Department of General Surgery,Chengdu Second People's Hospital,Chengdu,Sichuan 610017,China)

机构地区：[1]成都市第二人民医院肾内科,四川成都610017 [2]成都市第二人民医院普外科,四川成都610017

出　　处：《现代临床医学》2021年第6期404-407,共4页Journal of Modern Clinical Medicine

基　　金：成都市卫生健康委员会医学科研课题(2020144)。

摘　　要：目的:探讨有腹部手术史的终末期肾病患者行腹膜透析的效果及并发症情况。方法:选择我院行腹膜透析治疗患者85例,根据患者既往有无腹部手术史分为观察组25例和对照组60例,比较两组患者腹膜透析置管术前临床指标、手术相关指标及术后并发症。结果:观察组血浆白蛋白、全段甲状旁腺素低于对照组(P<0.01),而血红蛋白高于对照组(P<0.05)。观察组腹腔镜下置管比例、手术费用高于对照组(P<0.01)。两组患者术后30 d行腹膜平衡试验显示总Kt/v、总Ccr值均达标,差异无统计学意义(P>0.05)。观察组中仅网膜包裹、腹壁疝及阴囊水肿发生率高于对照组(P<0.01),其余并发症比较差异无统计学意义(P>0.05)。结论:有腹部手术史的终末期肾病患者行腹膜透析效果仍然较好,且透析后的多数常见并发症发生率并未显著增加,推荐采用腹腔镜下置管对此类患者行腹膜透析。Objective:To investigate the effect and complications of peritoneal dialysis in patients with end-stage renal disease and a history of abdominal surgery.Methods:85 patients undergoing peritoneal dialysis in our hospital were selected and divided into observation group(n=25,with a history of abdominal surgery)and control group(n=60,without a history of abdominal surgery).Clinical indicators before peritoneal dialysis catheterization,catheterization-related indicators and complications after catheterization were compared between the two groups.Results:The plasma albumin and intact parathyroid hormone in the observation group were significantly lower than those in the control group(P<0.01),while the hemoglobin was significantly higher than that in the control group(P<0.05).The proportion of laparoscopic catheterization and operation cost in the observation group were significantly higher than that in the control group(P<0.01).The peritoneal balance test 30 days after operation showed that the total Kt/V and total Ccr reached the standard,and the difference was not statistically significant between the two groups(P>0.05).Only the incidence rates of omental wrapping,abdominal hernia and scrotal edema in the observation group were higher than those in the control group(P<0.01),and there were no significant differences in other complications(P>0.05).Conclusion:The effect of peritoneal dialysis is still good in patients with end-stage renal disease and a history of abdominal surgery.Moreover,the incidences of most of common complications after dialysis do not increase significantly.Laparoscopic catheterization is recommended for peritoneal dialysis in such patients.

关 键 词：终末期肾病 腹部手术史 腹膜透析 

分 类 号：R692.5[医药卫生—泌尿科学]