超声引导下使用多功能膀胱造瘘穿刺针经皮腹膜透析置管术与开腹置管术的临床对比研究

Clinical comparison between ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar and open abdominal catheterization

目的:比较超声引导下使用多功能膀胱造瘘穿刺针经皮腹膜透析置管术与外科开腹置管术的安全性和有效性。方法:选取2016年6月至2018年7月在重庆医科大学附属永川医院腹透中心诊断终末期肾脏病(end stage renal disease,ESRD)且自愿选择腹膜透析的患者242例为研究对象。其中93例采用彩超引导下使用多功能膀胱造瘘穿刺针经皮穿刺置管术(A组),149例采用外科开腹手术置管术(B组)。术后对所有患者随访1年,回顾性分析2组患者的导管临床成功率、早晚期并发症发生率及导管1年技术生存率。采用SPSS 17.0统计软件进行数据分析。结果:2组患者在性别、年龄、腹部手术史方面无统计学差异(P>0.05)。A组手术切口长度、手术时间均短于B组(P<0.05),A组的早期腹膜炎发生率、晚期出口及隧道感染发生率均低于B组(P<0.05),A组的导管临床成功率和导管1年技术生存率均高于B组。但2组患者在术中并发症、导管移位、管周渗漏、腹壁疝、腹透管堵管方面无统计学差异(P>0.05)。结论:超声引导下使用多功能膀胱造瘘穿刺针经皮穿刺置管术更安全、更有效,可作为一种替代传统开腹置管术的方式。

Objective:To compare the safety and effectiveness of ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar and open abdominal catheterization. Methods:A total of 242 patients who were diagnosed with end-stage renal disease(ESRD)and who voluntarily chose the peritoneal dialysis in the peritonea dialysis center of Yongchuan Hospital of Chongqing Medical University from June 2016 to July 2018 were selected as study objects. Among them,93 patients were treated with ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar(group A),and 149 patients were treated with traditional open abdominal catheterization(group B). After surgery,all patients were followed up for one year;the success rate of clinical catheterization,incidence of early-and-late complications and one-year technical survival rate of catheter in two groups were retrospectively analyzed. SPSS 17.0 statistical software was used for data analysis. Results:Gender,age and history of abdominal operation in two groups had no significant differences(P>0.05).Incision length and operation time in the group A were all shorter than those in the group B(P<0.05). Incidence of early peritonitis and incidence of advanced catheter-end and tunnel infection in the group A were lower than those in the group B(P<0.05). Success rate of clinical catheterization and one-year technical survival rate of catheter in the group A were higher than those in the group B(P<0.05). Intraoperative complications,catheter displacement,perivascular leakage,abdominal hernia and abdominal tube occlusion in two groups had no significant differences(P>0.05). Conclusion:Ultrasound-guided percutaneous peritoneal dialysis catheterization with multifunctional bladder fistulation paracentesis trocar is safer and more effective,and can be used as an alternative to traditional open abdominal catheterization.