B超引导下经皮穿刺腹膜透析置管术与开放外科腹膜透析置管术的比较  

Comparison between B ultrasound guided percutaneous puncture and open surgical insertion of peritoneal catheter

作　　者：林沛鸿[1] 曲廖准[1] 唐小玲[1] 李拱榆[1] 王加伟[1] 吴泽归[1] 陈灶彬 LIN Pei-hong;QU Liao-zhun;TANG Xiao-ling;LI Gong-yu;WANG Jia-wei;WU Ze-gui;CHEN Zao-bin(Department of Nephrology,Central Hospital of Shantou,Shantou 515041,Guangdong,China)

机构地区：[1]汕头市中心医院肾内科,广东汕头515041

出　　处：《广东医学》2022年第9期1165-1171,共7页Guangdong Medical Journal

基　　金：汕头市医疗卫生科技计划项目(191221225263380)。

摘　　要：目的比较B超引导下经皮穿刺(Seldinger法)腹膜透析置管术与开放外科腹膜透析置管术的临床应用效果。方法单中心随机对照研究。随机选取肾内科收治的行腹膜透析手术治疗的患者,采用随机分组方式,将患者分为对照组和观察组,对照组接受传统的腹膜透析置管术,观察组接受B超引导下经皮穿刺(Seldinger法)腹膜透析置管术,共纳入103例腹膜透析置管术患者。其中对照组有1例术后失访,予剔除;观察组有1例术后1月死于心肌梗死,排除与置管相关,予剔除。观察组共51例,对照组共50例。对比两组患者的疗效。比较两组患者置管过程、置管后1年内腹膜透析管相关合并症和腹膜透析相关感染的发生率,探讨这两种腹膜透析置管术临床效果的差异,寻找适合的腹膜透析置管方式。所有患者均由同一主刀医师手术操作。结果所有观察对象透析无一例患者出现渗漏、肠穿孔、血性腹透液、隧道炎等导管相关性并发症。观察组的手术切口长度(1.74±0.30)cm、对照组的手术切口长度(4.11±0.10)cm,差异有统计学意义(Z=-9.17,P<0.001)。观察组的手术时间(46.08±5.13)min、对照组的手术时间(59.70±6.01)min,差异有统计学意义(Z=-8.09,P=0.001)。观察组的术中出血量(5.96±3.24)mL、对照组的术中出血量(8.10±2.45)mL,差异有统计学意义(Z=-3.48,P<0.001)。术后1个月腹膜透析相关性腹膜炎发生情况观察组低于对照组,差异有统计学意义(χ^(2)=4.54,P=0.033)。随访1年观察组出口感染率和对照组出口感染率差异无统计学意义(P=0.243)。观察组漂管率和对照组漂管率均为0。观察组腹腔脏器系膜或大网膜包裹率和对照组腹腔脏器系膜或大网膜包裹率均为0。观察组疝气率和对照组疝气率差异无统计学意义(P=0.495)。观察组隧道炎和对照组隧道炎均为0。腹膜透析相关性腹膜炎两组差异无统计学意义(χ^(2)=0.29,P=0.592)。随访1�Objective To compare the clinical effect of B ultrasound guided percutaneous puncture and open surgical insertion of peritoneal catheter.Methods A single-center randomized controlled study was conducted.The patients in renal department with peritoneal dialysis surgical treatment were randomly selected.The patients were randomized into control group and experimental group.The control group received the traditional peritoneal dialysis tube placement-open surgical insertion,while the experimental group received B ultrasound guided percutaneous puncture(Seldinger method)peritoneal dialysis tube placement.A total of 103 patients with peritoneal dialysis tube placement were involved.One patient in the control group was lost to postoperative follow-up,and one patient in the experimental group died of myocardial infarction in one month after the operation.There were 51 patients in the experimental group and 50 patients in the control group.The efficacy between the two patient groups was compared.The incidence of tube placement,peritoneal dialysis tube-related mechanical complications and peritoneal dialysis-related infections within 1 year were compared.The difference in the clinical effect of these two peritoneal dialysis catheterization were compared.All patients were operated by the same chief surgeon.Results None of the patients on dialysis had those catheter-related complications,including leakage,intestinal perforation,and infection.The length of the incision in the experimental group was(1.74±0.30)cm and in the control group was(4.11±0.10)cm,with significant difference between them(Z=-9.17,P<0.001).The operation time in experimental group and control group were(46.08±5.13)min and(59.70±6.01)min,respectively,with significant difference between them(Z=-8.09,P=0.001).The blood loss in experimental group and control group were(5.96±3.24)mL and(8.10±2.45)mL,respectively,with significant difference between them(Z=-3.48,P<0.001).There was significant difference in the peritoneal dialysis-related peritonitis rates b

关 键 词：B超引导 腹膜透析置管术 并发症 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]