改良腹膜透析导管重置术的临床研究

The clinical application of modified peritoneal dialysis catheter revision of malfunctioning catheter

目的 探讨改良腹膜透析导管重置术的临床应用效果,为腹膜透析导管功能障碍患者寻找一种简单、安全、有效的术式。方法 对2013年5月~2019年12月于浙江大学医学院附属第一医院肾脏病中心的76例腹膜透析导管功能障碍的患者行改良腹膜透析导管重置术,观察手术前一般情况,手术相关指标,术后并发症等。结果 所有患者均顺利实施改良重置术。初次置管至发生导管功能障碍时间为(335.3±556.3)天。导致功能障碍者中,漂管45例,网膜包裹10例,堵管7例,漂管及网膜包裹10例,漂管及堵管3例,其他1例;重置术手术时间(74.44±25.93)min,手术中出血量(21.17±2.94)ml;截至2021年9月1日,随访时间(38.68±26.76)月,重置术后仅1例腹膜炎后出现堵管,2例发生术后早期腹膜炎,所有患者均未发生再次漂管、网膜包裹、腹腔脏器损伤、胸腹瘘、切口感染、手术相关隧道感染等情况。导管失功率为2.6%,2例患者分别因渗漏及腹壁疝退出腹膜透析。结论 改良腹膜透析导管重置术具有操作简单、安全、创伤小、疗效好,术后并发症少,尤其是极大地减少了再次功能障碍的发生,值得临床推广应用。

Objective To investigate the clinical efficacy of the modified peritoneal dialysis catheter revision technique, and to find a simple, safe and effective operation for patients with malfunctioning catheter.Methods A total of 76 patients with malfunctioning catheter were enrolled, who received the modified peritoneal dialysis catheter revision operation from May 2013 to December 2019 in the First Affiliated Hospital of Zhejiang University. The general condition before and during operation, postoperative complications were observed. Results All patients were managed successfully, with a catheter revision operation time of(74.44 ±25.93)minutes and operative hemorrhage of(21.17 ± 2.94)ml. The mean onset time to catheter malfunction was(335.3 ± 556.3)days. Amongst the 76 patients, catheter malposition occurred in 45, omental wrapping in10, catheter occlusion in 7, catheter malposition with omental wrapping in 10, catheter malposition with occlusion in 3, and 1 case of others. During the follow-up time [(38.68 ± 26.76)months], there was only 1patient occurring catheter occlusion after peritonitis and 2 patients with early peritonitis(within 14 days after operation).There was no recurrence of catheter malposition and omental wrapping, and no organ injury, hydrothorax, incision infection and surgery-related tunnel infection. The rate of catheter malfunction was 2.6%, of which were due to dialysate leakage and abdominal wall hernia. Conclusions Our modified peritoneal dialysis catheter revision technique is a simple, safe and effective procedure. This procedure has the advantages of less trauma,less complications, minimized or even eliminated the possibility of recurrence of catheter malfunction, which is worthy of clinical application.