预防性大网膜部分切除对腹膜透析导管功能障碍发生的影响

Effect of preventive partial omentum resection on peritoneal dialysis catheter malfunction

目的:观察预防性切除部分大网膜对腹膜透析导管功能障碍的发生以及术后腹腔出血、腹透液渗漏、腹膜透析相关性腹膜炎和透析效率的影响。方法:研究分为大网膜部分切除组和对照组。大网膜部分切除组患者于腹膜透析置管时,切除部分大网膜;对照组予常规开放式手术置管。比较2组术后导管功能障碍及其它并发症的发生率以及置管前及透析3-6月后血肌酐(Scr)、尿素(urea)和二氧化碳总量(TCO2)差异。结果:大网膜部分切除组导管功能障碍发生率明显低于对照组(P<0.05),2组血性透出液、腹透液渗漏、腹膜炎发生率无明显差异。置管前,观察组Scr(P<0.05)、urea(P<0.05)明显高于对照组,2组之间TCO2无明显差异;透析后2组Scr、urea、TCO2无明显差异;2组透析后Scr、urea、TCO2较腹膜透析前均明显改善。结论:预防性切除部分大网膜可明显降低导管功能障碍发生率,但不降低腹膜透析效率,也不增加术后腹腔出血、腹透液渗漏和腹膜透析相关性腹膜炎发生率。

AIM： To observe the effect of preventive partial omentum resection on the incidence of peritoneal dialysis （PD） catheter malfunction, celiac hemorrhage after surgical placement of PD catheters, PD fluid leakage, and PD related peritonitis and PD efficiency. METHODS： The patients were divided into partial omentum resection group and control group. The patients in partial omentum resection group underwent partial greater omentum resection during PD catheter placement surgery. The patients in control group underwent routine surgical placement of PD catheters. The incidences of PD catheter malfunctions, haemic dialysates, PD fluid leakage and PD related peritonitis were compared between two groups. Serum creatinine, urea and total CO2 （ TCO2 ） were also determined before placement of PD catheters and PD for 3 -6 months. RESULTS： The incidence of PD catheter malfunction in partial omentum resection group was significantly lower than that in control group （ P 〈 0. 05 ）. The incidences of haemic dialysates, PD fluid leakage and PD related peritonitis had no significant difference between two groups. Before placement of PD catheters, serum creatinine and urea in partial omentum resection group were significantly higher than those in control group. TCO2 had no significant difference between two groups. After PD, serum creatinine, urea and TCO2 had no significant difference between two groups. Serum creatinine, urea and TCO2 after PD were significantly improved as compared to those before placement of PD catheters in two groups. CONCLUSION： Preventive partial omentum resection significantly decreases the incidence of PD catheter malfunction with no decrease in PD efficiency and no increase in the incidence of celiac hemorrhage, PD fluid leakage and PD related peritonitis.