超声引导下Seldinger法经皮穿刺腹膜透析置管术的临床应用

Ultrasound-guided percutaneous insertion of peritoneal dialysis catheters with the Seldinger technique

目的:观察超声引导下Seldinger法经皮穿刺腹膜透析(PD)置管术的临床特点,评估近中期患者的并发症、转归及导管技术生存率。方法:回顾性分析2018年1月至2020年1月间国家肾脏疾病临床医学研究中心在超声引导下行Seldinger法经皮穿刺PD置管术的患者一般资料、术中及术后特点、术后并发症、导管技术生存率,所有患者术后至少随访期半年。结果:共收集49例患者,男性28例,女性21例,平均年龄44.1±13.3岁。手术时间为23.4±2.4 min,腹部切口长度2.6±0.3 cm,平均术后12h即开始PD治疗。术中腹腔出血1例(约20 ml),经PD液冲洗后出血消失;术后出现血性PD液2例,3d后血性PD液均消失;术后3d出现渗漏合并疝气、导管移位、网膜包裹各1例。所有患者均未出现腹膜炎、切口处感染、隧道感染、愈合不良等。术后1个月1例患者因网膜包裹改血液透析治疗,1例患者肾功能恢复拔除PD导管。术后3个月1例患者导管移位经保守治疗成功复位。结论:超声引导下Seldinger法经皮穿刺PD置管术相对安全、简便、损伤小,并发症少,值得在临床推广。

Objective:To observe clinical effect of ultrasound-guided percutaneous insertion of peritoneal dialysis(PD)catheters with the Seldinger technique,evaluate the complication,outcome and catheter survival rate in these patients.Methodology:Clinical features,intra-and post-operative characteristics,postoperative complication and catheter technique survival rate of patients with the percutaneous Seldinger method of PD catheters insertion recruited from January 2018 to January 2020 were retrospectively analyzed.All patients were followed up for at least half a year.Results:A total of 49 patients were included with a mean age of 44.1±13.3 years old.Catheter insertion time was 23.4±2.42 minutes,the length of abdominal incision was 2.6±0.3 cm.Initial PD treatment began on average 12 hours after catheterization.Intraperitoneal hemorrhage about 20 ml occurred in 1 case during the operation,and the hemorrhage disappeared after being rinsed with dialysate.Two cases of hemorrhagic dialysate occurred postoperatively,and disappeared 3 days later.Leakage with hernia,catheter displacement and omental wrapping occurred 3 days postoperatively in each 1 case.None of the patients had peritonitis,incision infection,tunnel infection,poor healing,etc.One patient underwent hemodialysis treatment due to omental wrapping 1 month after catheterization,1 case of catheter was removed after renal function recovery 1 month after catheterization.Conclusion:Ultrasound-guided Seldinger percutaneous peritoneal dialysis catheterization is a relatively safe,simple,less invasive and less complicated technique,which is worthy spreading.