Schmidt Sven C, Pohle Cosima, Langrehr Jan M, Schumacher Guido, Jacob Dietmar, Neuhaus Peter
Clinic for General-, Visceral-, and Transplantation Surgery, Charité Campus Virchow-Klinikum, University Medicine Berlin, Berlin, Germany.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):596-9. doi: 10.1089/lap.2006.0162.
Peritoneal dialysis is a generally accepted method for the treatment of patients with end-stage renal failure. The laparoscopic placement of peritoneal dialysis catheters is a well-established technique and offers some advantages, such as a safer placement of the catheter, less post-operative complications, and a longer functional survival, compared to the conventional open technique. The aim of this study was to describe our implantation technique and to determine the results of our approach.
Between January 2000 and February 2006, 47 patients with end-stage chronic renal failure underwent a laparoscopic peritoneal dialysis catheter insertion procedure. Perioperative and follow-up data were collected prospectively.
The mean operating time was 35 minutes (range, 16-100). There was no perioperative morbidity. Nine (19.1%) patients experienced 10 mechanical complications: fluid leakage in 6 (12.8%) patients, acute hydrothorax in 1 (2.1%), catheter tip migration in 2 (4.3%), and catheter obstruction in 1 (2.1%) patient. Episodes of peritonitis were observed in 5 (10.6%) patients. One (2.1%) patient developed a catheter infection. In 3 (6.4%) patients, a port site hernia occurred that required surgical repair, 5 (10.6%) patients underwent laparoscopic revisions owing to mechanical complications, 9 (19.1%) patients underwent renal transplantation, and 6 (12.8%) patients died during the later follow-up. After a mean follow-up time of 17 months (range, 2-76), 30 (63.8%) catheters are still in use for dialysis.
The functional outcome of the dialysis catheters was satisfactory in the majority of patients in this study. The described technique for catheter implantation is simple and safe, and in our opinion, the laparoscopic technique should be considered as the method of choice in patients with end-stage chronic renal failure.
腹膜透析是治疗终末期肾衰竭患者普遍认可的方法。与传统开放技术相比，腹腔镜下放置腹膜透析导管是一项成熟的技术，具有一些优势，如导管放置更安全、术后并发症更少以及功能存活时间更长。本研究的目的是描述我们的植入技术并确定我们方法的结果。
2000年1月至2006年2月期间，47例终末期慢性肾衰竭患者接受了腹腔镜腹膜透析导管插入手术。前瞻性收集围手术期和随访数据。
平均手术时间为35分钟（范围16 - 100分钟）。无围手术期发病情况。9例（19.1%）患者出现10例机械性并发症：6例（12.8%）患者发生液体渗漏，1例（2.1%）患者出现急性胸腔积液，2例（4.3%）患者导管尖端移位，1例（2.1%）患者导管阻塞。5例（10.6%）患者发生腹膜炎。1例（2.1%）患者发生导管感染。3例（6.4%）患者出现切口疝，需要手术修复，5例（10.6%）患者因机械性并发症接受腹腔镜翻修，9例（19.1%）患者接受肾移植，6例（12.8%）患者在后期随访期间死亡。平均随访17个月（范围2 - 76个月）后，30根（63.8%）导管仍用于透析。
本研究中大多数患者的透析导管功能结果令人满意。所描述的导管植入技术简单且安全，我们认为，对于终末期慢性肾衰竭患者，腹腔镜技术应被视为首选方法。
