改良腹腔镜腹膜透析置管术的初步临床疗效分析(附40例报告)  

Preliminary clinical effect of modified laparoscopic peritoneal dialysis catheterization:with a report of 40 cases

作　　者：褚朋[1] 郭春艳 黄勇[1] 支良[1] 李锋[2] CHU Peng;GUO Chunyan;HUANG Yong(Department of Hepatobiliary Vascular Surgery,Zaozhuang Municipal Hospital,Zaozhuang 277100,China;Department of Nephrology,Zaozhuang Municipal Hospital)

机构地区：[1]枣庄市立医院肝胆血管外科,山东枣庄277100 [2]枣庄市立医院肾内科

出　　处：《腹腔镜外科杂志》2023年第8期619-623,共5页Journal of Laparoscopic Surgery

摘　　要：目的:探讨改良腹腔镜腹膜透析置管术治疗终末期肾脏疾病的临床疗效及安全性。方法:选择2020年12月至2022年6月收治的40例终末期肾脏疾病患者作为研究对象,均行改良腹腔镜腹膜透析置管术,记录患者一般资料、围手术期情况(技术成功率、手术时间、术后疼痛评分、术后住院时间)、近期并发症(腹腔出血、切口疼痛、渗漏、导管移位、导管阻塞、腹膜炎)、远期并发症(导管移位、腹膜炎、切口疝、渗漏、导管阻塞)。结果:40例患者中男27例,女13例,平均(52.3±13.1)岁;糖尿病肾病17例、慢性肾小球肾炎16例、其他7例。40例患者腹膜透析管均放置成功,手术时间20~25 min,平均(22.3±1.6)min。2例患者腹膜透析时流出淡血性液体,均于术后第2天消失。术后7~9 d出院,随访时间8.5(5,10)个月。1例患者术后3个月出现脐部切口疝,发生率2.5%;未发生渗漏、导管移位、导管阻塞、腹膜炎等并发症。结论:改良腹腔镜腹膜透析置管术微创、安全、有效,穿刺成功后可早期进行腹膜透析,临床效果良好,适于排除手术禁忌证的需要腹膜透析的患者。Objective:To investigate the clinical efficacy and safety of modified laparoscopic peritoneal dialysis catheterization in the treatment of end-stage renal disease.Methods:The modified laparoscopic peritoneal dialysis catheterization was performed in 40 patients with end-stage renal disease from Dec.2020 to Jun.2022.The baseline characteristics,perioperative conditions(technical s uccess rate,surgical time,postoperative pain score,postoperative hospital stay),the incidence of recent complications(abdominal h emorrhage,incision pain,leakage,catheter shift,catheter blockage,peritonitis),and long-term complications(catheter shift,peritonitis,incisional hernia,leakage,catheter blockage)were recorded.Results:Among the 40 patients enrolled in the study,27 patients were males,and 13 patients were females.The mean age was(52.3±13.1)years.The primary diseases included diabetic nephropathy(n=17),chronic glomerulonephritis(n=16)and others(n=7).All the operations were completed successfully,and catheterization r equired only 20-25 min,and the mean time was(22.3±1.6)min.2 cases of mild bloody liquid were found during peritoneal dialysis,and disappeared on the second day after surgery.The patients were discharged 7-9 d following the operations and the follow-up time was 8.5(5,10)months.Umbilical incisional hernia occurred in 1 patient 3 months after operation,with an incidence of 2.5%.No leakage,catheter shift,catheter blockage and peritonitis were observed.Conclusions:The modified laparoscopic peritoneal dialysis catheterization is minimally invasive,safe and effective,after successful puncture,peritoneal dialysis can be carried out at an early stage.Good clinical results can been achieved in this procedure,which is applicable to all patients who need peritoneal dialysis without surgical contraindications.

关 键 词：腹膜透析 腹腔镜检查 导管插入术 

分 类 号：R656[医药卫生—外科学]