改良腹腔镜腹膜透析管置管与开腹置管的临床效果对比观察

Clinical comparison of modified laparoscopic and conventional placement of peritoneal dialysis catheters

目的探讨肾脏病科医生实施腹腔镜下腹壁悬吊法腹膜透析置管术的临床效果。方法选择浙江省人民医院肾脏病科2011年1月至2016年5月住院手术的188例患者，分别采用腹腔镜下腹壁悬吊法（改良腹腔镜置管组）（A组）59例和常规开腹手术法（开腹手术组）（B组）129例行腹膜透析管置管术，并对两组患者的一般情况、原发病、既往手术史、检验结果、手术时间、术后近期及远期并发症、手术费用等进行对比分析。结果A组既往腹部手术史比例11．9％，而B组为0（χ^2=15．897，P〈0．001）；A组手术时间（38．9±12．8）min，而B组（64．1±12．7）min（t=-6．4666，P=0．0000）；A组手术费用（5488．4±156．1）元，而B组（1602．7±48．9）元（t=257．129，P=0．0000）；1个月内导管移位A组为0，B组11．6％（χ^2=7．4553，P=0．003）；A组术后疼痛为15．3％，B组为41．9％（χ^2=12．8622，P=0．000）；1个月后导管移位A组是0，B组是16．3％（χ^2=10．8124，P=0．000）；1个月后A组疝气13．6％，B组为3．1％（χ^2=7．4105，P=0．010）。两组在腹腔出血、术后1个月内和1个月后腹膜炎、胸腹漏、导管堵塞等差异无统计学意义（P〉0．05）。结论腹腔镜下腹壁悬吊法腹膜透析置管术在慢性肾衰竭既往有腹部手术史、重新置腹透管、手术时间、减少腹透管移位、减少术中及术后疼痛等方面有优势，但仍存在渗漏、疝气等并发症。

Objective To explore the clinical efficacy of the modified laparoscopic placement of peritoneal dialysis catheters by nephrologists. Methods A total of 188 patients diagnosed as end-stage renal disease （ESRD） were enrolled, who received catheter and continuous ambulatory peritoneal dialysis （CAPD） therapy from January 2011 to May 2016 in Zhejiang Provincial People＇s Hospital. They were divided into group A （ with modified laparoscopic placement of peritoneal dialysis catheters, n = 59 ） and group B （with conventional placement of peritoneal dialysis catheter, n = 129 ）. The demographic and clinical characteristics, past abdominal operation history, surgery time, hospital stay after operation, expenses for surgery and hospitalization, early and late complications including bleeding, pain, leakage, peritonitis and catheter displacement were observed. Results Patients with previous abdominal surgery accounted for 11.9% in group A and 0 in group B（χ^2 = 15. 897 ,P 〈 0. 001 ）. The duration of the operation was （38. 9 ± 12. 8）min in group A and （64. 1 ± 12. 7）rain in group B（t = -6. 466 6, P =0. 000 0）. The cost of the operation was （5 488.4 ± 156. 1 ） yuan in group A and （ 1 602. 7 ±48. 92） yuan in group B （t = 257. 129, P =0. 000 0）. Catheter displacement within one month was observed in 0 and 11.6% （χ^2 = 7.455 3, P = 0.003）, pain in 15.3% and 41.9% （χ^2 = 12. 862 2, P = 0.000）, and catheter displacement after one month in 0 and in 16. 3% （χ^2 = 10. 812 4, P =0. 000） of the patients, respectively in group A and group B. The incidences of peritonitis within one month and beyond one month, leakage,bleeding and so on showed no difference between the two groups （P 〉 0. 05）. Conclusions Placement of PD catheter with laparoscope is suitable for renal failure patients with abdominal operation history and replacement PD catheter. It also has the advantages of shorter surgery time, less pain and lower incidences of catheter displacement, expanding the application of PD. However, bleeding, leakage, hernia and other complications are frequently seen.