摘要
目的:比较腹腔镜下腹膜透析(PD)置管术与开腹手术的疗效和安全性。方法:选取上海市第八人民医院肾内科、上海市东方医院肾内科自2010年10月至2012年10月愿意接受PD治疗的终末期肾病患者共28例,采用患者自愿选择方法,分为开腹手术组(A组)和腹腔镜组(B组),记录手术患者术前基本情况,手术时间、术中出血量,术后疼痛时间、下床活动时间、腹腔出血、伤口感染和腹膜粘连等术后并发症以及腹膜透析相关并发症等情况。结果:腹腔镜组手术时间、术中出血量、术后疼痛时间、下床活动时间、腹腔出血、伤口感染和腹膜粘连等并发症明显优于开腹手术组(P均<0.05)。随访2年内,A组腹膜炎发生率为15%,高于B组的12.5%,但差异无统计学意义(P=0.608)。B组无出口隧道感染和渗漏等并发症发生,而A组各有1例发生(P均<0.01)。A组有3例导管移位和2例引流不畅发生,而B组没有,差异具有统计学意义(P<0.05)。结论:与常规开腹手术相比较,腹腔镜腹膜透析置管术创伤小、并发症少、术后患者康复快,发生导管移位率、引流不畅率显著降低,是改善腹膜透析置管手术风险和减少并发症的较理想的手术方式。
Objective：To compare the efficacy and safety between laparoscopic and conventional place-ment of peritoneal dialysis（PD） catheter in patients with end-stage renal disease（ESRD）.Method：28 pa-tients were selected as candidates ,who received catheter implantation and PD therapy from October 2010 to October 2012 in shanghai No 8 peopole hospital and shanghai dongfang hospital .They were randomly divided into two group A（with conventional placement of PD catheter ,n=30） and group B（with laparoscopic place-ment of PD catheter,n=21）.The clinical characteristic,surgery time, intraoperative blood loss, postoperative pain time, bed time, abdominal bleeding ,wound infection peritoneal adhesion ,and complications associated with PD were observed .Result：The complications such as the surgery time , intraoperative blood loss , post-operative pain time , bed time , abdominal bleeding ,, wound infection peritoneal adhesion in group B were better significantly than those in group A （ P＆lt;0.05） .In 2 years of follow-up,the total incidence of peritonitis was 13.3%in group A and 9.9%in group B, and there was no significant difference statistically （P=0.608）. There were no complications with exit/tunnel infection and peritoneal leak in group B ,while 1 case in group A respectively（P＆lt;0.01）.There were 3 cases with PD catheter shift and no-free drainage in group A,while 1 case in group B （ P＆lt;0.05,respectively ） .Conclusion：With comparision to conventional placement of perito-neal dialysis cathters ,laparoscopic placement had advantages such as smaller trauma ,decreased complications and shorter postoperative recovery time .Through the beneficial decreasement of PD catheter shift and drain-age,the laparoscopic placement of PD catheters is an ideal operation method for peritoneal dialysis .
出处
《河北医学》
CAS
2014年第4期562-566,共5页
Hebei Medicine
关键词
腹膜透析
腹腔镜检查
腹膜炎
并发症
Peritoneal dialysis
Laparoscopy
Peritonitis
Complication
