摘要
目的 探讨腹腔镜手术在尿毒症患者腹膜透析治疗中的应用价值.方法 2007年9月～2011年5月对16例未腹透的尿毒症患者采用腹腔镜下置管.气腹后,观察全腹腔,先将腹透管置于腹腔,末端固定于腹腔底部,然后将腹透管由旁侧5 mm插管处引出,使内涤纶套刚好在腹膜外,无须荷包缝合,术后自行生长闭合.同时对手术粘连、疝、卵巢囊肿或较多的大网膜予以相应处理.同期对6例已腹透的患者反复引流不畅判定有大网膜包裹,腹腔镜下行超声刀切除,并固定末端.结果 16例首次置管的手术操作时间平均26.8 min（25～40 min）,6例大网膜包裹手术操作时间平均38.6 min（30～46 min）.术后1 d内排气,肠功能恢复满意.无腹腔脏器损伤、腹膜炎等并发症发生.首次置管者16例随访2年,均未发生大网膜包裹,未发生漂移;6例大网膜包裹随访2年,均未发生再次大网膜包裹,未发生漂移,无渗漏.结论 腹腔镜手术内固定有效防止漂管,对清除已包裹透析管的大网膜和预防包裹有良好效果,但由于无荷包缝合容易出现渗漏,需要进一步完善手术方法.
Objective To explore the value of laparoseopic surgery for the treatment of uremia in peritoneal dialysis. Methods From September 2007 to May 2011, 16 cases of uremia were placed PD catheter under laparoscopy. After pneumoperitoneum was established, we observed the whole abdominal cavity, placed the dialysis tube in the abdominal cavity, then fixed the tube end at the bottom of the abdominal cavity. The dialysis tube was pulled out from the 5 mm trocar at the flank to leave Kraft just outside the peritoneum. Purse-string suture was not needed. The lesion was self-closed postoperatively. Surgical adhesions, hernia, ovarian cysts, and redundant omentum were treated at the same time. Due to poor drainage, six cases of peritoneal dialysis were diagnosed as greater omentums wrapping the tube, which were dissected by ultrasound scalpel and fixed. Results The operative time of the 16 cases of first-time catheterization was 25 -40 min（ average, 26.8 min） ; the operative time of the 6 cases of greater omentums wrapping was 30 -46 min （average, 38.6 rain）. The intestinal function recovered 1 day after operation. No abdominal cavity damage, peritonitis or other complications occurred. The 16 cases of first-time catheterization was followed up for 2 years and no greater omentums wrapping or drifting was observed. The 6 cases of greater omentums wrapping were followed up for 2 years and no recurrence, drifting or leaking was observed. Conclusions Laparoscopic fixation can effectively prevent tube from drifting, and remove the greater omentums wrapping the tube. However, as no purse-string suture is prone to leakage, we need to further improve the surgical method.
出处
《中国微创外科杂志》
CSCD
2014年第2期126-128,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
腹腔镜
尿毒症
腹膜透析
Laparoscope
Uremia
Peritonea dialysis
