腹膜透析套管针穿刺置管术和传统开腹置管术的回顾性病例对照研究

A retrospective case-control study:modified trocar peritoneal dialysis catheter implantation and open peritoneal dialysis catheter implantation

目的回顾性分析腹膜透析套管针穿刺置管术和传统开腹置管术的临床应用效果。方法采用单中心回顾性病例对照研究。纳入2016年1月至2018年5月在成都医学院第一附属医院行腹膜透析置管手术并术后规律随访的125例维持性腹膜透析患者作为研究对象,根据不同手术方式分为两组,接受套管针穿刺置管术的患者64例(A组),接受传统开腹置管术的患者61例(B组),分析两组置管过程、置管术后并发症及技术生存率。结果(1)A组较B组置管手术操作时间短[(32.5±6.8)min比(57.8±14.2)min],手术切口长度短[(2.8±0.5)cm比(4.1±0.6)cm],术中出血量少[(8.2±0.9)mL比(13.9±2.5)mL],术中疼痛评分低[(3.8±0.8)分比(7.2±0.9)分](P<0.05)。(2)A组总技术生存率高于B组(98.4%比90.2%);A组1年、2年和3年技术生存率均为98.1%,优于B组1年技术生存率(91.6%)、2年技术生存率(89.4%)和3年技术生存率(89.4%),差异具有统计学意义(P<0.05)。(3)A组术后并发症的发生率较B组低[漂管(6.3%比13.1%)、漏液(1.6%比4.9%)、出血(1.6%比6.6%)],但差异无统计学意义(P>0.05)。结论腹膜透析套管针穿刺置管术较传统开腹置管手术操作时间短、手术切口长度短、术中出血量少、术中疼痛度低,且技术生存率更高,值得临床上推广应用。

Objective To explore the clinical efficacy of modified Trocar peritoneal dialytic catheter implantation versus open peritoneal dialytic catheter implantation.Methods For this single-center retrospective study,a total of 125 patients were reviewed between January 2016 and May 2018.They were divided into two groups according to different surgical approaches(n=64,group A)Modified Trocar peritoneal dialysis catheter implantation and open peritoneal dialysis catheter implantation(n=61,group B)were performed.The clinical data of implanting procedures,postoperative complications and technical survival rate were analyzed.Results As compared with group B,operative duration was shorter[(32.5±6.8)min vs.(57.8±14.2)min],length of incision shorter[(2.8±0.5)cm vs.(4.1±0.6)cm],volume of intraoperative bleeding less[(8.2±0.9)mL vs.(13.9±2.5)mL]and intraoperative pain score lower(3.8±0.8 vs.7.2±0.9)in group A(P<0.05).The 1/2/3-year technical survival rate was 91.6%,89.4%and 89.4%in group B versus all 98.1%in group A.And the differences were statistically significant(P<0.05).The incidence of postoperative complications was lower in group A than that in group B,including catheter shifting(6.3%vs.13.1%),leakage(1.6%vs.4.9%)and bleeding(1.6%vs.6.6%).However,there was no significant statistical difference(P>0.05).Conclusions As compared with traditional open peritoneal dialytic catheter implantation,modified Trocar peritoneal dialytic catheter implantation is worth wider popularizing in clinical practices because of shorter operative duration,shorter incision,less intraoperative bleeding,milder intraoperative pain and higher technical survival rate.