Department of Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
J Am Coll Surg. 2010 Dec;211(6):699-704. doi: 10.1016/j.jamcollsurg.2010.08.010. Epub 2010 Oct 29.
Continuous ambulatory peritoneal dialysis (CAPD) catheters provide a preferred alternative to hemodialysis in a growing population with chronic kidney disease. However, CAPD catheters traditionally have been associated with a high rate of nonfunction with both open and laparoscopic procedures. New advanced laparoscopic techniques using rectus sheath tunneling and omentopexy have been reported to improve catheter function.
This study retrospectively reports the Cleveland Clinic experience during the transition from basic to advanced laparoscopic techniques from June 2002 to July 2008. A total of 197 patients were identified: 68 who underwent insertion with basic techniques and 129 who received catheters with advanced techniques. Primary nonfunction, procedural complications, and overall nonfunction rate were analyzed using the most recent follow-up to June 2008.
Primary nonfunction occurred in 25 of 68 (36.7%) patients in the basic group; this occurred in only 6 of 129 patients (4.6%) in the advanced group (p < 0.0001). The overall rate of complications including nonfunction from primary and secondary sources, peritoneal leak, peritonitis, port-site hernia, and bleeding occurred in 31 of 68 (45.6%) patients in the basic group and 21 of 129 (16.28%) patients in the advanced group (p < 0.0001).
These data clearly show a significant improvement in CAPD catheter function using omentopexy and rectus sheath tunneling. These advanced laparoscopic techniques should become the preferred method of CAPD catheter insertion.
在慢性肾脏病患者群体不断增长的情况下，持续非卧床腹膜透析（CAPD）导管为血液透析提供了一种较好的替代方法。然而，传统上 CAPD 导管与开放式和腹腔镜手术都有较高的无功能率相关。据报道，使用腹直肌鞘隧道和网膜固定术的新的先进腹腔镜技术可以改善导管功能。
本研究回顾性报告了克利夫兰诊所 2002 年 6 月至 2008 年 7 月期间从基本腹腔镜技术向先进腹腔镜技术过渡的经验。共确定了 197 例患者：68 例接受基本技术插入，129 例接受先进技术导管。使用截至 2008 年 6 月的最新随访结果分析原发性无功能、手术并发症和总无功能率。
基本组 68 例患者中有 25 例（36.7%）发生原发性无功能；而先进组 129 例患者中仅 6 例（4.6%）发生原发性无功能（p < 0.0001）。原发性和继发性来源的并发症发生率包括无功能、腹膜渗漏、腹膜炎、端口疝和出血，基本组 68 例患者中有 31 例（45.6%），先进组 129 例患者中有 21 例（16.28%）（p < 0.0001）。
这些数据清楚地表明，使用网膜固定术和腹直肌鞘隧道技术可显著改善 CAPD 导管功能。这些先进的腹腔镜技术应成为 CAPD 导管插入的首选方法。
