García-Cruz E, Vera-Rivera M, Corral Molina J M, Mallafré-Sala J M, Alcaraz A
Servicio de Urología, Hospital Clínic de Barcelona, Barcelona.
Nefrologia. 2010;30(3):354-9. doi: 10.3265/Nefrologia.pre2010.Apr.10412.
To test the feasibility, efficacy and safety of a new two port laparoscopic technique for dialysis catheter placement.
From January 2006 to July 2009 51 patients underwent dialysis catheter placing using an original technique. All procedures were finished laparoscopically using two 12 mm-sized ports. Our technique bases on placing Oreopoulos-Zellerman catheter along a straight Guyon s guide with atraumatic tip, visually guaranting optimal placement. Catheter can be repositioned if desired by reentering the guide. Median follow-up was 25 months.
Mean operating time was 32 minutes (range 15-55 minutes). One patient suffered an immediate postoperative catheter obstruction that required surgical repositioning. No other technical intra or early postoperative complications related to technique were reported. Mean time to discharge 1.02 +/- 2.2 days. Catheter outflow failure rate was 7.6%. Conversion to haemodialysis due to peritonitis 13%. Peritonitis per patient/year was 0.27. Catheter 6 mo, 1 year and 2 year survival rate was 94%, 87% and 72%. Catheter migration rate was 4%. There was no peritoneal dialysis liquid leakage.
The two ports technique described is an easy and rapid procedure, with few complications and early discharge. Due to its reliability, offers good catheter function outcome.
测试一种用于透析导管置入的新型双端口腹腔镜技术的可行性、有效性和安全性。
2006年1月至2009年7月，51例患者采用原技术进行透析导管置入。所有手术均通过两个12毫米大小的端口在腹腔镜下完成。我们的技术是将奥雷奥普洛斯-泽勒曼导管沿着带有无创伤尖端的直盖永导丝放置，通过视觉确保最佳放置位置。如有需要，可重新插入导丝来重新定位导管。中位随访时间为25个月。
平均手术时间为32分钟（范围15 - 55分钟）。1例患者术后立即出现导管阻塞，需要手术重新定位。未报告其他与技术相关的术中或术后早期并发症。平均出院时间为1.02±2.2天。导管流出失败率为7.6%。因腹膜炎转为血液透析的比例为13%。每位患者每年的腹膜炎发生率为0.27。导管6个月、1年和2年的生存率分别为94%、87%和72%。导管迁移率为4%。无腹膜透析液渗漏。
所描述的双端口技术操作简便、迅速，并发症少且出院早。因其可靠性，导管功能结局良好。
