改良经皮穿刺腹膜透析置管术在紧急起始腹膜透析中的应用

Application of modified percutaneous technique of peritoneal dialysis catheter placement in urgent-start peritoneal dialysis patients

目的探讨改良经皮穿刺腹膜透析置管术在紧急起始腹膜透析中应用的安全性及有效性。方法选取76例行腹膜透析的终末期肾脏病患者,分别采用改良经皮穿刺法(A组34例)和常规开腹手术法(B组42例)完成置管后开始紧急起始腹膜透析,对2组患者的一般情况、原发病、手术时间、术后早期及远期并发症等进行对比分析。结果A组在手术时间上短于B组(t=-6.142,P=0.009),术后早期渗漏的发生率、术后早期导管移位的发生率及术后远期导管移位的发生率均低于B组(χ^2值分别为8.341,7.523,11.724;P值分别为0.001,0.003,<0.001),腹直肌出血发生率高于B组(χ^2=5.272,P=0.018);2组在网膜包裹、腹膜炎、疝、胸腹瘘方面的差异无统计学意义(χ^2值分别为0.659,0.091,0.148,0.148;P值分别为0.191,0.958,0.809,0.809)。结论在紧急起始腹膜透析中,改良经皮穿刺腹膜透析置管术是一种有效的、安全的、容易掌握的置管方式,与常规开腹手术法相比,手术时间更短,早期渗漏和导管移位的发生率低,值得临床推广。

Objective This study assessed the efficacy and safety of the modified percutaneous peritoneal dialysis catheter placement in urgent-start peritoneal dialysis patients.Methods A total of 76 patients diagnosed as end-stage renal disease were enrolled,they were divided into group A(with modified percutaneous placement of peritoneal dialysis catheter,n=34)and groupB(with conventional placement of peritoneal dialysis catheter,n=42).The demographic and clinical characteristics,past abdominal operation history,surgery time,hospital stay after operation,early and late complications were observed.Results The operative time of group A was shorter than that of group B(t=-6.142,P=0.009),the incidence of leakage in group A was lower than group B within one month(χ^2=8.341,P=0.001),the incidence of catheter displacement in group A was lower than group B within one month(χ^2=7.523,P=0.003),the incidence of rectus abdominis hemorrhage in group A was higher than group B(χ^2=5.272,P=0.018);the incidence of catheter displacement in group A was lower than group B after one month(χ^2=11.724,<0.001),the incidences of omentum wrapping(χ^2=0.659,P=0.191),peritonitis(χ^2=0.091,P=0.958),pleuro-abdominal fistula(χ^2=0.148,P=0.809)and hernia(χ^2=0.148,P=0.809)showed no difference between the two group.Conclusions The modified percutaneous placement of peritoneal dialysis catheter is effective,safe and easy to learn,which reduce leakage and catheter displacement significantly compared with conventional placement of peritoneal dialysis catheter,and worth clinical promotion in urgent-start peritoneal dialysis patients.