3种不同腹膜透析置管手术方式的对比研究  

The study of comparing three different cannula operations for peritoneal dialysis

作　　者：陈彬 孙承斌 周建波 励黎 韩利娜 Chen Bin;Sun Chengbin;Zhou Jianbo;Li Li;Han Lina(Department of Kidney,Ningbo Zhenhai People's Hospital,Ningbo 315202,Zhejiang,China)

机构地区：[1]宁波市镇海区人民医院肾内科,浙江宁波315202

出　　处：《中华危重病急救医学》2021年第9期1084-1087,共4页Chinese Critical Care Medicine

基　　金：浙江省医药卫生科技计划项目(2021KY1062,2019KY200);浙江省宁波市镇海区公益类科技计划项目(2018S1011)。

摘　　要：目的观察腹腔镜下腹膜透析(腹透)置管、经皮穿刺置管和常规手术置管3种手术方式在腹透治疗中的临床疗效。方法选择2015年5月3日至2020年2月14日宁波市镇海区人民医院收治的87例终末期肾脏病行腹透患者作为研究对象。按患者意愿分为腹腔镜下置管组(23例)、经皮穿刺置管组(29例)和常规手术置管组(35例)。比较3组患者一般资料、围手术情况(手术时间、术后住院时间)、近期并发症(腹腔出血、腹直肌出血、切口疼痛、渗漏、导管移位、腹膜炎)和远期并发症(导管移位、腹膜炎、疝气、胸腹瘘、腹透管阻塞)发生率的差异。结果与常规手术置管组比较,腹腔镜下置管组和经皮穿刺置管组手术时间均明显缩短(min:32.5±12.3、28.9±11.8比61.3±15.4,均P<0.05),术后腹腔镜下置管组和经皮穿刺置管组住院时间均有缩短趋势(d:9.8±3.4、9.2±2.6比10.7±3.2),但3组比较差异无统计学意义(P>0.05)。腹腔镜下置管组和经皮穿刺置管组近期并发症中腹腔出血、腹直肌出血、切口疼痛发生率均明显低于常规手术置管组〔腹腔出血发生率:4.3%(1/23)、3.4%(1/29)比22.9%(8/35),腹直肌出血发生率:4.3%(1/23)、3.4%(1/29)比22.9%(8/35),切口疼痛发生率:8.7%(2/23)、10.3%(3/29)比42.9%(15/35),均P<0.01〕,而腹腔镜下置管组与经皮穿刺置管组上述指标比较差异无统计学意义;腹腔镜下置管组导管移位发生率均较经皮穿刺置管组和常规手术置管组明显降低〔4.3%(1/23)比27.6%(8/29)、31.4%(11/35),均P<0.05〕。远期并发症中腹腔镜下置管组导管移位发生率较经皮穿刺置管组和常规手术置管组明显降低〔4.3%(1/23)比24.1%(7/29)、31.4%(11/35),均P<0.05〕,但常规手术置管组与经皮穿刺置管组比较差异无统计学意义;腹腔镜下置管组疝气发生率明显高于经皮穿刺置管组和常规手术置管组〔21.7%(5/23)比3.4%(1/29)、2.8%(1/35),均P<0.05〕,且均为脐疝;但常�Objective To observe the clinical effect of the cannula under laparoscopy,percutaneous puncture cannula,and conventional surgery cannula for peritoneal dialysis.Methods From May 3,2015 to February 14,2020,87 patients with end-stage renal disease needing peritoneal dialysis in Ningbo Zhenhai People's Hospital were enrolled.These patients were divided into three groups including cannula under laparoscopy(23 cases),percutaneous puncture cannula(29 cases),and conventional surgery cannula(35 cases).The baseline characteristics,perioperative conditions(surgical time,post-surgical hospitalization time),the incidence of recent complications(abdominal hemorrhage,direct abdominal hemorrhage,incision pain,leakage,catheter shift,peritonitis),and long-term complications(catheter shift,peritonitis,hernia,thoracic and abdominal fistula,abdominal tube obstruction)among the three groups were compared.Results Compared with the group of conventional surgery cannula,the operation time in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly shorter(minutes:32.5±12.3,28.9±11.8 vs.61.3±15.4,both P<0.05),the in-hospital stay in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were reduced(days:9.8±3.4,9.2±2.6 vs.10.7±3.2),but there was no statistical significance among the three groups(P>0.05).The incidence of abdominal bleeding,rectus abdominis bleeding,and incision pain in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly lower than those in the group of conventional surgery cannula[incidence of abdominal bleeding:4.3%(1/23),3.4%(1/29)vs.22.9%(8/35),incidence of rectus abdominis bleeding:4.3%(1/23),3.4%(1/29)vs.22.9%(8/35),incidence of incision pain:8.7%(2/23),10.3%(3/29)vs.42.9%(15/35),all P<0.01].The difference between the group of cannula under laparoscopy and the group of percutaneous puncture cannula had no statistical significance.Compared with the group of conventional surgery can

关 键 词：腹膜透析 腹腔镜 腹膜透析置管 经皮穿刺 

分 类 号：R692.5[医药卫生—泌尿科学]