Department of Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Perit Dial Int. 2010 Jan-Feb;30(1):41-5. doi: 10.3747/pdi.2008.00121.
Patients with previous history of abdominal operations are sometimes excluded from consideration for peritoneal dialysis because of concerns for increased risk of complications during the implantation procedure and inadequate dialysis due to reduced peritoneal surface area. Employing a laparoscopic approach, we compared the outcome of peritoneal dialysis catheters in 2 groups of patients with and without intra-abdominal adhesions.
All data in this report were recorded prospectively. Revision-free and overall survival of catheters, the incidence of mechanical and infectious complication, and surgical revision rates were compared between the 2 groups.
In 217 successful catheter implantations, there was a history of previous abdominal surgery in 42.9% of procedures; only 26.9% of them had intraperitoneal adhesions; 2.8% of patients without history of previous abdominal surgery had intraperitoneal adhesions. There were no significant differences between the 2 groups for 1- and 2-year revision-free and overall catheter survival, mechanical dysfunction, infectious complications, or surgical revision rates.
History of previous abdominal surgery should not be used to judge the eligibility of patients for peritoneal dialysis. Laparoscopic placement is the best way to ensure optimal catheter outcomes equivalent to patients without previous abdominal surgery.
由于担心在植入过程中并发症风险增加和由于腹膜表面积减少导致透析不充分，有腹部手术史的患者有时会被排除在腹膜透析考虑之外。我们采用腹腔镜方法，比较了有和无腹腔内粘连的两组患者腹膜透析导管的结果。
本报告中的所有数据均前瞻性记录。比较了两组患者导管的无修订生存率和总生存率、机械和感染并发症的发生率以及手术修订率。
在 217 例成功的导管植入术中，42.9%的手术有腹部手术史；只有 26.9%的患者有腹腔内粘连；2.8%无腹部手术史的患者有腹腔内粘连。两组患者的 1 年和 2 年无修订生存率和总生存率、机械功能障碍、感染并发症或手术修订率无显著差异。
既往腹部手术史不应作为判断患者腹膜透析资格的依据。腹腔镜放置是确保最佳导管结果的最佳方法，与无既往腹部手术史的患者相当。
