腹腔镜下IPOM在CAPD并发腹膜透析管旁疝患者中的应用

Application of IPOM lead by laparoscope in peridialysis hernia patients undergoing CAPD

目的总结腹腔镜下腹腔内补片置入术(IPOM)应用于持续性非卧床腹膜透析(CAPD)并发腹膜透析管旁疝患者的治疗经验。方法回顾性分析2014年1月至2018年1月6例应用腹腔镜IPOM治疗CAPD并发腹膜透析管旁疝患者的临床资料。结果6例患者平均年龄(59.7±9.1)岁,其中男2例,女4例;6例患者均因终末期肾病(肾小球滤过率<15mL·min^-1·1.73m^-2)而行CAPD治疗;引起肾功能不全的原发病中,糖尿病4例,原发性高血压1例,慢性肾小球肾炎1例;6例患者术前均经2周的血液透析过渡治疗后进行手术,手术中应用强生proceed防粘连补片进行腹腔镜下IPOM修补腹膜透析管旁疝,同时在腹腔镜的引导下于对侧腹壁重新放置腹膜透析管,本组患者腹壁缺损直径(3.1±0.6)cm,手术时间(55.0±15.2)min,术后住院时间(6.0±1.7)d。术后无切口感染、腹透液渗漏、导管堵塞、腹膜透析管移位及严重并发症的出现。术后半年随访均未见疝复发病例。结论对于CAPD并发腹膜透析管旁疝的患者,只要做好充分的术前准备,腹腔镜下IPOM术的近期疗效是肯定的。

Objective To summarize the experience of intraperitoneal onlay mesh(IPOM)lead by laparoscope in the treatment of continuous ambulatory peritoneal dialysis(CAPD)complicated with peridialysis hernia.Methods The clinical data of 6 patients with CAPD complicated with peridialysis hernia treated by IPOM lead by laparoscope from January 2014 to January 2018 were retrospectively analyzed.Results The average age of the 6 patients,including 2 males and 4 females,in this group was(59.7±9.1)years old.All the patients were treated with CAPD due to end-stage renal disease(glomerular filtration rate<15 mL·min^-1·1.73 m^-2).The primary diseases causing renal insufficiency included 4 cases of diabetes,1 case of hypertension,and 1 case of chronic glomerulonephritis.All of the 6 patients underwent hemodialysis for 2 weeks before surgery.During the operation,anti-adhension mesh was used to repair the peridialysis hernia,and the peritoneal dialysis tube was replaced on the contralateral abdominal wall under the guidance of laparoscope.The diameter of abdominal wall defect in this group was(3.1±0.6)cm,the operation time was(55.0±15.2)min,and the postoperative hospital stay was(6.0±1.7)d.There was no incision infection,leakage of peritoneal fluid,catheter blockage,and transabdominal tube displacement after operation,and no serious complications occurred.No cases of recurrent hernia was observed during the six months of follow-up.Conclusion For patients with CAPD complicated with peridialysis hernia,the short-term efficacy of IPOM lead by laparoscope is positive as long as adequate preoperative preparation is available.