儿童三种不同腹膜透析置管术式并发症分析

The complications of three different techniques of peritoneal dialysis catheters placement in children

目的分析儿童腹膜透析置管术不同术式并发症的发生率，提高慢性肾功能不全患儿腹膜透析置管术成功率。方法2001年至2011年我院因慢性肾功能不全接受腹膜透析置管术患儿共38例，男22例，女16例，平均年龄（9．45±4．03）岁，对其腹膜透析置管术的术式、术后相关并发症进行回顾性分析。根据术式不同分为腹腔镜组8例、开放切除大网膜组17例、开放保留大网膜组13例，前两组术中均切除大网膜。所有患儿均采用全身麻醉，使用Tyco双cuff腹膜透析直导管。术后透析门诊定期随访3个月～5年。结果术后近远期并发症共12例，其中因导管失功需要二次手术患儿8例，腹腔镜组1例（12．5％），开放切除大网膜组1例（5．9％0），开放保留大网膜组6例（46．2％）。大网膜切除组与大网膜未切除组比较，因导管失功而需要二次手术的发生率明显降低（8％比46．2％，P〈0．05）。结论儿童腹膜透析置管术中切除大网膜可以有效减少术后导管堵塞，降低二次手术发生率，而腹腔镜手术与普通开放手术切除大网膜比较术后并发症发生率及二次手术率相当。

Objective To study the complications of three different techniques of peritoneal dial- ysis catheters placement in pediatric patients with renal failure. Methods Between 2001 and 2011, chil- dren who underwent peritoneal dialysis catheters placement in this center were recruited in this study. According to the technique to place the peritoneal dialysis catheters, the patients were divided into 3 groups., laparoscopic surgery with omentectomy, open surgery with the preservation of omentum, and open surgery with omentectomy. The procedure and complications of these children were retrospective- ly analyzed. All procedures were performed under general anesthesia and the catheters were from the same company with two cuffs. Results Thirty-eight patients were reviewed, including 22 males and 16 females. Their mean age was 9. 45 ± 4. 03 years old. About 65.8G patients underwent omentectomy. Complications were observed in 12 children. Reoperation was performed on 8 children for catheter fail- ure,including 1 （12. 55） underwent laparoscopic surgery, 1 （5. 9%） underwent open surgery and omentectomy,and 6 （46. 25） underwent open surgery with the preservation of omenturra Catheter failure and reoperation was significantly reduced in the patients with the resection of omentum （P〈 0. 05）. Conclusions The catheter failure and reoperation rate is not different between the patients with laparoscopic surgery and open surgery with omentectomy to place peritoneal dialysis catheter. The reo- peration rate can be reduced lay omentectomy.