改良单孔腹腔镜在腹膜透析置管术中的应用

Application of Modified Single-port Laparoscope in Peritoneal Dialysis Catheterization

目的:比较改良单孔腹腔镜下腹膜透析置管术与常规置管术的疗效及安全性。方法:选取赣南医学院第一附属医院肾内科2014年9月-2016年6月接受腹膜透析治疗的终末期肾病患者150例,根据患者的意愿,分为腹腔镜组(n=50)及常规手术组(n=100)。比较两组患者术前一般情况、手术情况、术后并发症发生情况及术后住院天数。结果:腹腔镜组的手术时间、术中出血量及手术切口长度均优于常规手术组,差异均有统计学意义(P<0.05)。随访后发现,腹腔镜组出现腹膜炎4例,腹透管漂管3例,透析液渗漏4例,出口及隧道感染1例,切口疝2例;常规手术组出现腹膜炎7例,腹透管漂管7例,透析液渗漏2例,出口及隧道感染2例,切口疝1例,两组不良反应发生率比较,差异均无统计学意义(P>0.05)。且两组患者均未出现腹透管堵塞及腹腔脏器损伤。腹腔镜组患者术后的住院时间短于常规手术组,差异有统计学意义(P<0.05)。结论:与常规手术相比较,改良单孔腹腔镜腹膜透析置管术创伤小、并发症少、术后患者康复快,是改善腹膜透析置管手术风险和减少并发症的较理想的手术方式,临床运用前景良好,值得推广。

Objective: To compare the efficacy and safety of modified single-port laparoscopic peritoneal dialysis catheterization with conventional catheterization. Method: A total of 150 patients with end-stage renal disease who received peritoneal dialysis from September 2014 to June 2016 in the Department of Nephrology, the First Affiliated Hospital of Gannan Medical College were selected, they were divided into laparoscopic group(n=50) and conventional operation group(n=100) according to the wishes of the patients. The general condition before operation, operation condition, postoperative complications and hospital stay were compared between the two groups. Result: The operation time, intraoperative blood loss and incision length of the laparoscopic group were all better than those of the conventional operation group, with statistically significant differences(P<0.05). After follow-up, 4 cases of peritonitis, 3 cases of peritoneal tube drift, 4 cases of dialysate leakage, 1 case of exit and tunnel infection, and 2 cases of incisional hernia were found in the laparoscopic group, in the conventional operation group, there were 7 cases of peritonitis, 7 cases of peritoneal tube drift, 2 cases of dialysate leakage, 2 cases of exit and tunnel infection, and 1 case of incisional hernia, there were no statistically significant differences in the incidence of adverse reactions between the two groups(P>0.05). In addition, none of the patients in the two groups had any obstruction of abdominal tube or abdominal organ injury. The postoperative hospital stay of patients in the laparoscopic group was shorter than that in the conventional surgery group, with statistically significant difference(P<0.05). Conclusion: Compared with conventional surgery, modified single-port laparoscopic peritoneal dialysis catheterization is an ideal method to relieve the risk of peritoneal dialysis catheterization and reduce complications, it has a good prospect of clinical application and is worth promoting.