Vaccarisi S, Spadafora N, Bonaiuto E, Crocco V, Garrini A N, De Marco E, Rizzuti S, Pellegrino V, Tortorella M, Mollica A, Bonofiglio R, Cavallari G, Nardo B
Hepato-Biliary-Pancreatic and Transplant Organs Unit, Department of Surgery, Annunziata Hospital, Cosenza, Italy.
Transplant Proc. 2012 Sep;44(7):1873-5. doi: 10.1016/j.transproceed.2012.05.058.
Among the available devices for peritoneal dialysis, the Di Paolo self-locating catheter (SLC) represents a milestone using to its ability to ensure a permanent reliable means of access to the peritoneum. Our experience included 20 laparoscopic peritoneal catheter placements from 2008 to 2011. We performed the laparoscopic surgical technique using 3 trocars: 2 10 mm and 1 5 mm. The technique allows catheter introduction into the pouch of Douglas under direct vision. Among 20 treated patients, 1 died due to causes unrelated to peritoneal dialysis; 1 underwent transplantation, and 1 was switched to hemodialysis because of ultrafiltration failure. The complications included 2 catheter displacements, only 1 of them needing repositioning by open laparotomy, and 1 case of peritonitis. No infection in the subcutaneous tunnel or obstruction and malfunction occurred among our patients. The Di Paolo SLC is similar to Tenckhoff catheter but includes a small tungsten cylinder at the tip that engenders continuous gravity in the peritoneal cavity, producing a reduced risk of dislocation. In a large series of cases, Di Paolo et al. reported a 0.8% dislocation rate after SLC placement compared with 12% using Tenckhoff catheters. They also demonstrated a reduced risk of other complications, such as peritonitis, infection, obstruction, and failure. These data have been confirmed by other authors with smaller case series. Thus, introduction of the SLC and improved surgical techniques result in better efficiency of peritoneal dialysis.
在现有的腹膜透析设备中，迪保罗自定位导管（SLC）堪称一个里程碑，因其能够确保建立一种永久性可靠的腹膜通路。我们的经验涵盖了2008年至2011年间20例腹腔镜下放置腹膜导管的病例。我们采用3个套管针进行腹腔镜手术技术操作：2个10毫米的和1个5毫米的。该技术可在直视下将导管置入Douglas陷凹。在20例接受治疗的患者中，1例因与腹膜透析无关的原因死亡；1例接受了移植，1例因超滤失败转而接受血液透析。并发症包括2例导管移位，其中仅1例需要通过开腹手术重新定位，以及1例腹膜炎。我们的患者中未发生皮下隧道感染或梗阻及功能障碍。迪保罗SLC与Tenckhoff导管相似，但在尖端包含一个小钨圆柱体，可在腹膜腔内产生持续重力，降低移位风险。在一系列大量病例中，迪保罗等人报告SLC放置后移位率为0.8%，而使用Tenckhoff导管的移位率为12%。他们还证明了其他并发症的风险降低，如腹膜炎、感染、梗阻和衰竭。其他作者的较小病例系列也证实了这些数据。因此，SLC的引入和手术技术的改进提高了腹膜透析的效率。
