腹腔镜下与开放式手术治疗腹膜透析管大网膜包裹的比较

Comparison of laparoscopic and open surgery to resolve the omental wrapping of peritoneal dialysis catheter

目的:比较腹腔镜下松解复位术与开放式腹膜透析(PD)管拔除及重新安置术治疗PD管大网膜包裹的临床疗效及手术费用。方法:选择第二军医大学长海医院肾内科2006年01月～2011年06月PD管大网膜包裹经保守治疗无效的患者30例:根据患者意愿行腹腔镜下PD管大网膜包裹松解复位术(腹腔镜松解组)18例,开放式大网膜包裹的PD管拔除及重新安置术(开放手术重置组)12例。记录患者一般情况、手术时间、手术切口大小、手术费用、术后随访3月内再次出现PD管大网膜包裹例数。结果:两组患者一般情况、术后再次出现PD管大网膜包裹比例(腹腔镜松解组vs开放手术重置组:38.89%vs33.33%,P>0.05)无差别。手术时间腹腔镜松解组少于开放手术重置组[(26.00±8.51)minvs(92.80±16.08)min,P<0.05]、手术切口长度腹腔镜松解组短于开放手术重置组[(1.52±0.43)cmvs(4.38±1.30)cm,P<0.05]、手术费用腹腔镜松解组多于开放手术重置组[(7392.45±522.10)元vs(2822.96±159.29)元,P<0.05]。结论:尽管腹腔镜技术具有创伤小、手术时间短等优点,但手术费用高,可能再次发生PD管大网膜包裹。因此腹腔镜下包裹松解复位术较开放式PD管拔除及重新安置术治疗PD管大网膜包裹无明显优势,仅行腹腔镜下包裹松解复位术不能明显减少大网膜包裹的再次发生,且其同时行大网膜折叠术、大网膜固定术、大网膜部分切除术可有助减少PD管大网膜包裹的再次发生,建议腹腔镜医生采用上述新方法,以减少大网膜包裹的再次发生。

Objective：To compare the clinical effect and cost between laparoscopic and open surgery that resolve the omental wrapping of peritoneal dialysis catheter. Methodology： Thirty patients with peritoneal dialysis were diagnosed omental wrapping of peritoneal dialysis catheter during January 2006 to June 2011. According to patients＇ willingness, two types of operations were performed： laparoscopic surgery （the catheter was released from the wrapping omentum and repositioned in the pelvis under laparoscopy, n = 18 ） and open surgery （the omentum-wrapped catheter was removed and a new catheter was reimplanted,n = 12 ）. The clinical parameters were collected, such as general conditions, operative time, incision length, operation cost and recurrence of omental wrapping. Results：The parameters such as general conditions, recurrence of omental wrapping （ 38.9% vs 33.3% ） between two groups showed no significant statistical difference respectively （P 〉0. 05）. The operative time of laparoscopic surgery was shorter than that of open surgery [ （26.0 ±8.51 ） mins vs （92. 8 ±16. 1 ） mins,P 〈0. 05]. The incision length of laparoscopic surgery was shorter than that of open surgery [ （ 1.52 ± 0. 43 ） cm vs 4. 38 ± 1.30） cm, P 〈 0. 051. The cost of laparoscopic surgery was more expensive than that of open surgery [ （7 392 ±522）yuan vs （2 823 ±159）yuan,P 〈0. 05]. Conclusion：Allhongh the laparoscopic surgery showed advantages of small trauma and a short span of time, high cost and the recurrence of omental wrapping of peritoneal dialysis catheter still existed. There were no obvious advantages between two types of operations in resolving omental wrapping of peritoneal dialysis catheter. Laparoscopic technique （repositioning with omentum folding, partial omentectomy ） may be helpful in preventing the recurrence of omental wrapping.