微型腹腔镜置管术在有腹部手术史慢性肾衰竭患者中的应用及透析充分性研究

Effect of dialysis catheter emplacement and dialysis adequacy after loosen adhesions using mini-laparoscopy on patients with a history of abdominal surgery

目的:探讨微型腹腔镜下置管术在曾有腹部手术史慢性肾衰竭患者中的应用效果及其对透析充分性的影响。方法:对19例既往有腹部手术史的慢性肾衰竭患者行微型腹腔镜下置管术,观察置管效果及透析充分性。结果:术中腹腔探查示腹腔无明显黏连、无需松解7例,需在腹腔镜下行不同程度松解黏连手术12例。术中19例患者均在腹腔镜直视下成功置入腹膜透析管,无需松解黏连手术者的手术时间约10 min,需松解黏连手术者的手术时间30 min～3 h。术中所有患者均无发生并发症,于术后5～7 d出院。腹腔镜下置管术后,19例慢性肾衰竭患者均接受间歇性腹膜透析。随访4～48个月,腹膜透析时所有患者的尿素清除指数KT/V值均超过1.7,所有患者的腹膜透析管均无移位,未发生腹膜透析液腹腔外渗漏,未发现有导管近、远期功能障碍。患者伤口均愈合良好,外表美观,无发生感染病例。结论:曾有腹部手术史的患者并不是腹膜透析的相对禁忌证,该类患者经过黏连松解手术后仍可行腹膜透析并达到透析充分。

Objective：To explore the effect of dialysis catheter emplacement and dialysis adequacy after loosen adhesions using mini-laparoscopy on patients with a history of abdominal surgery.Methods： Nineteen chronic renal failure patients with history of abdominal surgery were treated with dialysis catheter emplacement by mini-laparoscopy.The effect of dialysis catheter implacement and dialysis adequacy were observed.Results： Seven patients out of 19 cases did not show intra-abdominal adhesions.Dialysis catheter emplacement was successfully put in those patients.After anesthesia the operation time lasted about 10 minutes.12 patients with adhesions required surgical release.The operation time lasted from 30 minutes to 3 hours.IPD was done at 5~7 days after surgery.Follow-up of 4~48 months showed no complications such as leakage.KT/V tests were greater than 1.7.Conclusions： Patients with history of abdominal surgery were suitable for dialysis catheter emplacement via mini-laparoscopic after abdominal exploration.Dialysis was adequate after surgical lysis of adhesions.