输尿管镜辅助下腹膜透析管置入技术的应用

Clinical application of the ureteroscope assistant placement of peritoneal dialysis catheters

目的:探讨输尿管镜辅助下腹膜透析管置入技术的临床应用安全性和疗效。方法:自愿选择腹膜透析替代治疗的终末期肾病患者32例,局麻下采用经皮微创穿刺技术,使用Peer-Away鞘建立腹腔通道,以输尿管镜进入腹腔内定位,并引导腹膜透析管置于膀胱直肠窝或子宫直肠窝,近端建立皮下隧道并经左下腹戳洞引出。结果:全部患者腹膜透析管均放置成功,手术时间(42±15)min,术中用20%盐酸利多卡因(13±5)ml,出血极少,仅4例术后出现淡血性腹水,腹水持续时间约(16±5)h,无因出血导致输血者。术后随访时间≥12月,均未见漂管、渗漏、堵管等腹膜透析常见并发症。结论:输尿管镜辅助下腹膜透析管置入技术是一种定位精确、安全可靠、并发症少的置管新方法,值得推广应用。

Objective：To evaluate the clinical feasibility,safety and effect of the ureteroscope assistant placement of peritoneal dialysis catheters in patients with end stage renal disease （ESRD）. Methodology ： Thirty two consecutive ESRD patients underwent ureteroscope assistant placement of peritoneal dialysis catheters. Informed consent form was signed by patients under principle of voluntary. All patients were eligible to receive local infiltration anesthesia. Ureteroscopic monitoring was performed via a peer-away sheath through an incision near the umbilicus. A catheter was passed through the peer-away sheath into the true pelvis. A subcutaneous tunnel was created and a point in left lower quadrant was selected as the exit site of the catheter. Results：All the catheters were successfully placed and the mean time of operation was （42 -＋ 15） minutes. The dose of additional local anesthetics during procedure is 20% lidocaine （ 13 ＋5） milliliter. Blood loss was very little in operation. Only 4 eases presented the ascites with little red blood cells which lasted （ 16 -＋ 5 ） hours. During mean follow-up period of 12 months, there were no catheter-related complications, such as catheter migration, obstruction, and dialysate leakage. Conclusion：The ureteroscope assistant placement of peritoneal dialysis catheters is worthy to be popularized for it＇s safty and effectiveness in end stage renal disease （ESRD） patients.