Lu Cu T, Watson David I, Elias Tony J, Faull Randall J, Clarkson Anthony R, Bannister Kym M
The University of Adelaide, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
ANZ J Surg. 2003 Mar;73(3):109-11. doi: 10.1046/j.1445-2197.2003.02651.x.
Since 1994 we have placed all peritoneal dialysis (Tenckhoff) catheters at our hospital laparoscopically using a technique that incorporates suture fixation into the pelvis. The purpose of this study was to determine the long-term outcome of this approach.
Perioperative and follow-up data for all patients undergoing placement of a peritoneal dialysis catheter at the Royal Adelaide Hospital were collected prospectively and managed on unit specific and hospital wide computerized databases. A total of 148 procedures were carried out in 123 patients from March 1994 to November 2001. Follow-up ranged from 3 to 68 months (median, 42 months). All procedures were undertaken or supervised by one surgeon, and catheters were routinely sutured into the pelvis at laparoscopy.
There was no perioperative mortality in this series, and only one catheter could not be placed laparoscopically. This was in a patient with extensive intra-abdominal adhesions. Mean operative time was 27 min (range, 10-100 min), and mean postoperative stay was 2.8 days (range, 1-12 days). Seven (5%) patients experienced peri/postoperative haemorrhage, and four of these underwent surgical re-exploration. Twenty-five (17%) catheters are still used for dialysis. Thirty-four (23%) catheters were removed when the recipient received a subsequent renal transplant, and 42 (28%) patients died during follow-up. Forty-six (31%) patients required catheter revision or removal because of technical problems; 26 (18%) recurrent peritonitis or exit site infection; and 20 (14%) catheter blockage. Twenty-eight reinsertion procedures were carried out in 25 patients. Ten (7%) patients developed port site hernias at late follow-up, and required hernioplasty. Catheter migration leading to malfunction (poor drainage) occurred in eight (5%) patients only.
Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure. The majority of patients will dialyse successfully using this technique. Suturing the catheter tip into the pelvis is associated with a low rate of catheter migration.
自1994年以来，我们医院一直采用一种将缝线固定于盆腔的技术，通过腹腔镜放置所有腹膜透析（Tenckhoff）导管。本研究的目的是确定该方法的长期效果。
前瞻性收集所有在皇家阿德莱德医院接受腹膜透析导管置入术患者的围手术期和随访数据，并在科室特定和全院范围的计算机数据库中进行管理。1994年3月至2001年11月，共对123例患者进行了148例手术。随访时间为3至68个月（中位数为42个月）。所有手术均由一名外科医生实施或监督，并且在腹腔镜检查时将导管常规缝合至盆腔。
本系列中无围手术期死亡病例，仅1例导管无法通过腹腔镜放置，该患者存在广泛的腹腔内粘连。平均手术时间为27分钟（范围为10 - 100分钟），平均术后住院时间为2.8天（范围为1 - 12天）。7例（5%）患者经历围手术期/术后出血，其中4例接受了再次手术探查。25例（17%）导管仍用于透析。34例（23%）导管在受者接受后续肾移植时被拔除，42例（28%）患者在随访期间死亡。46例（31%）患者因技术问题需要对导管进行翻修或拔除；26例（18%）因复发性腹膜炎或出口部位感染；20例（14%）因导管堵塞。25例患者进行了28次重新置入手术。10例（7%）患者在随访后期出现端口部位疝，需要进行疝修补术。仅8例（5%）患者发生导管移位导致功能障碍（引流不畅）。
腹腔镜放置腹膜透析导管是一种安全有效的手术。大多数患者使用该技术可成功进行透析。将导管尖端缝合至盆腔与导管移位率较低相关。
