低位两孔法腹腔镜下腹膜透析置管术的临床研究

The Clinical Application of Low-Position Two-Port Laparoscopic Technique for Peritoneal Dialysis Catheterization

目的比较低位两孔法腹腔镜下腹膜透析置管术与传统开腹置管术的疗效及安全性。方法选取2016年6月~2019年12月于浙江大学医学院附属第一医院肾脏病中心接受首次腹膜透析置管术并治疗的终末期肾病患者639例,分为低位两孔法腹腔镜下置管组(A组,n=147)及开腹组(B组,n=492),回顾性分析2组患者手术前一般情况、围手术期情况、手术后并发症及转归情况。结果A组的手术时间(t=-21.543,P<0.001)、住院时间(t=-2.398,P=0.017)较B组短,2组在手术中出血量(t=-0.011,P=0.991)、手术后疼痛(t=-1.650,P=0.100)、手术后腹膜透析开始时间(t=-0.211,P=0.833)、住院费用(t=-1.739,P=0.083)等比较无统计学差异;A组的漂管率(χ^(2)=7.516,P=0.006)、血性腹膜透析液(χ^(2)=4.675,P=0.031)发生率低于B组,2组在堵管(χ^(2)=0.762,P=0.383)、大网膜包裹(χ^(2)=0.010,P=0.921)、腹膜透析液渗漏(χ^(2)=0.182,P=0.544)、脏器损伤(χ^(2)=0.299,P=0.770)、疝(χ^(2)=0.042,P=0.838)、胸腹瘘(χ^(2)=0.003,P=0.955)等机械并发症及腹膜炎(2周内)(χ^(2)=0.182,P=0.670)等感染并发症上无明显统计学差异,2组均无隧道感染(2周内)发生;截至2021年9月1日,A组的导管技术生存率优于B组(Log-rankχ^(2)=4.696,P=0.030)。结论低位两孔法腹腔镜下腹膜透析置管术具有操作简单、安全、手术时间短、创伤小、手术后并发症少等优点,降低了漂管率,提高了导管技术生存率且不额外增加患者经济负担,值得临床推广应用。

Objective To compare the efficacy and safety of open and low-position two-port laparoscopic technique for peritoneal dialysis catheterization.Methods A total of 639 patients with end-stage renal disease were retrospectively analyzed,who received catheter and peritoneal dialysis therapy from June 2016 to December 2019 in the First Affiliated Hospital of Zhejiang University.For the placement of peritoneal dialysis catheters,147 patients underwent low-position two-port laparoscopic surgery(group A)and 292 patients were by open surgical method(group B).The general condition before operation,perioperative condition,postoperative complications and outcomes were compared between the two groups.Results The operation time(t=-21.543,P<0.001)and hospitalization time(t=-2.398,P=0.017)in group A were shorter than those in group B,while operative hemorrhage(t=-0.011,P=0.991),postoperative pain(t=-1.650,P=0.100),onset time of peritoneal dialysis(t=-0.211,P=0.833)and hospitalization expenses(t=-1.739,P=0.083)showed no difference.the incidence of catheter malposition(χ^(2)=7.516,P=0.006)and bloody effluent(χ^(2)=4.675,P=0.031)in group A were significantly lower than those in group B,while the other complications such as catheter occlusion(χ^(2)=0.762,P=0.383),omentum wrapping(χ^(2)=0.010,P=0.921),dialysate leakage(χ^(2)=0.182,P=0.544),organ injury(χ^(2)=0.299,P=0.770),hernia,hydrothorax(χ^(2)=0.003,P=0.955),and peritonitis(within 2 weeks)(χ^(2)=0.182,P=0.670)showed no difference.There was no tunnel infection event within 2 weeks in both groups.patients in group A had a favorable catheter technique survival rate compared with group B(Log-rankχ^(2)=4.696,P=0.030).Conclusions Our low-position two-port laparoscopic technique is a simple and safe procedure.This procedure can shorten the operation time,reduce the possibility of migration,trauma and complications,and improved the catheter technique survival rate without additional costs.This technique is worthy of clinical application.