Bar-Zohar Dan, Sagie Boaz, Lubezky Nir, Blum Miriam, Klausner Joseph, Abu-Abeid Subhi
Department of Surgery B, Tel Aviv Sourasky Medical Center, Israel.
Isr Med Assoc J. 2006 Mar;8(3):174-8.
Peritoneal dialysis is a widely accepted route for renal replacement. With the advent of endoscopy, many surgical techniques for the prevention of catheter failure have been proposed.
To evaluate the outcomes of patients undergoing laparoscopic Tenckhoff catheter implantation using the pelvic fixation technique.
Data analysis was retrospective. All procedures were performed under general anesthesia. A double-cuffed catheter was inserted using two 5 mm trocars and one 10 mm trocar, fixing its internal tip to the dome of the bladder and its inner cuff to the fascia. Catheter failure was defined as persistent peritonitis/exit-site/tunnel infection, severe dialysate leak, migration or outflow obstruction.
LTCI was performed in 34 patients. Mean patient age was 65 +/- 17 years. In 12 of the 34 patients the indication for LTCI was end-stage renal failure combined with NYHA class IV congestive heart failure. Operative time was 35 +/- 15 minutes. A previous laparotomy was performed in 9 patients. Hospital stay was 1.5 +/- 0.6 days. The first continuous ambulatory peritoneal dialysis was performed after 20 +/- 12 days. Median follow-up time was 13 months. There were several complications, including 5 (14%) exit-site/tunnel infections, 27 episodes (0.05 per patient-month) of bacterial peritonitis, 3 (9%) incisional hernias, 1 case of fatal intraabdominal bleeding, 2 (5.8%) catheter migrations (functionally significant), and 10 (30%) cases of catheter plugging, 8 of which were treated successfully by instillation of urokinase and 2 surgically. A complication-mandated surgery was performed in 8 patients (23.5%). The 1 year failure-free rate of the catheter was 80.8%. One fatal intraabdominal bleeding was recorded.
LTCI is safe, obviating the need for laparotomy in high risk patients. Catheter fixation to the bladder may prevent common mechanical failures.
腹膜透析是一种被广泛接受的肾脏替代途径。随着内镜技术的出现，人们提出了许多预防导管功能障碍的手术技术。
评估采用盆腔固定技术进行腹腔镜Tenckhoff导管植入术患者的治疗效果。
进行回顾性数据分析。所有手术均在全身麻醉下进行。使用两个5毫米套管针和一个10毫米套管针插入双套囊导管，将其内尖端固定于膀胱顶部，内套囊固定于筋膜。导管功能障碍定义为持续性腹膜炎/出口处/隧道感染、严重透析液渗漏、移位或流出道梗阻。
34例患者接受了腹腔镜Tenckhoff导管植入术。患者平均年龄为65±17岁。34例患者中有12例因终末期肾衰竭合并纽约心脏协会IV级充血性心力衰竭而接受腹腔镜Tenckhoff导管植入术。手术时间为35±15分钟。9例患者曾接受过剖腹手术。住院时间为1.5±0.6天。首次持续性非卧床腹膜透析在20±12天后进行。中位随访时间为13个月。出现了多种并发症，包括5例（14%）出口处/隧道感染、27次细菌性腹膜炎发作（每位患者每月0.05次）、3例（9%）切口疝、1例致命性腹腔内出血、2例（5.8%）导管移位（具有功能意义）以及10例（30%）导管堵塞，其中8例通过尿激酶灌注成功治疗，2例接受手术治疗。8例患者（23.5%）因并发症接受了手术。导管1年无功能障碍率为80.8%。记录到1例致命性腹腔内出血。
腹腔镜Tenckhoff导管植入术是安全的，无需对高危患者进行剖腹手术。将导管固定于膀胱可预防常见的机械性故障。
