Chen Wen-Li, Ding Guo-Hua, Zheng Zhi, Liu Chang-Xuan
Department of Nephrology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
Department of Hepatopancreatobiliary Surgery, Huazhong University of Science and Technology, Wuhan, 430014, China.
J Huazhong Univ Sci Technolog Med Sci. 2015 Feb;35(1):71-75. doi: 10.1007/s11596-015-1391-8. Epub 2015 Feb 12.
Peritoneal dialysis catheter surgery has been used in clinical treatment for nearly 40 years, and open surgery under local anesthesia is the conventional method. However, catheter displacement after open surgery is still the thorny issue during our clinical practice. Then the reset surgery is often required to be taken again. Nowadays, laparoscopic peritoneal dialysis catheter draws our attention due to its advantages of accurate positioning, smaller incision, and less pain, and its clinical application has been limited. While laparoscopic surgery is recognized, there are few relevant studies on whether there is difference during the catheter reset process between the two surgical approaches. In this study, we mainly discussed the rate of secondary catheter migration, the incidence of complications after catheter reset for two surgical approaches and the hospital stay as well as the total clinical cost for the two surgical approaches. In this study, we retrospectively analyzed 25 cases of end-stage renal disease, who received catheterization for peritoneal dialysis and regular peritoneal dialysis in our hospital from March 2010 to December 2013, and had a medical history of catheter migration. We collected the relevant clinical data for all patients. Fifteen patients selected laparoscopic catheter reset, and 10 patients selected the traditional surgical method for catheter reset by themselves. For all patients enrolled, we analyzed the incidence of secondary catheter migration and postoperative complications, hospitalization time, and total cost for different methods of reset. Through the studies above, we found that laparoscopic peritoneal dialysis catheter surgery offered accurate catheter location and a small incision that was easy to heal. Besides, the incidence of postoperative complications for the laparoscopic surgery was lower than that for traditional surgical approach for catheter reset. The average hospitalization time for laparoscopic surgery was shorter than that for the traditional surgical approach. The total cost of laparoscopic surgery was more than that of the traditional surgery. Therefore, the rational application of a laparoscopic peritoneal dialysis catheter and reset surgery can increase the success rate of peritoneal dialysis, reduce the complications, shorten hospitalization time of patients, and thus enhance patient's confidence to stick it out.
腹膜透析导管手术已在临床治疗中应用了近40年，局部麻醉下的开放手术是传统方法。然而，开放手术后导管移位仍是我们临床实践中的棘手问题。随后往往需要再次进行复位手术。如今，腹腔镜腹膜透析导管因其定位准确、切口小、疼痛轻等优点而受到关注，但其临床应用一直受到限制。虽然腹腔镜手术得到认可，但关于两种手术方式在导管复位过程中是否存在差异的相关研究较少。在本研究中，我们主要探讨了两种手术方式的二次导管移位率、导管复位后的并发症发生率、住院时间以及总临床费用。在本研究中，我们回顾性分析了25例终末期肾病患者，他们于2010年3月至2013年12月在我院接受腹膜透析置管及规律腹膜透析治疗，并有导管移位病史。我们收集了所有患者的相关临床资料。15例患者选择腹腔镜导管复位，10例患者自行选择传统手术方法进行导管复位。对于所有纳入的患者，我们分析了不同复位方法的二次导管移位发生率、术后并发症、住院时间及总费用。通过上述研究，我们发现腹腔镜腹膜透析导管手术导管定位准确，切口小且易于愈合。此外，腹腔镜手术的术后并发症发生率低于传统手术复位方法。腹腔镜手术的平均住院时间短于传统手术方法。腹腔镜手术的总费用高于传统手术。因此，合理应用腹腔镜腹膜透析导管及复位手术可提高腹膜透析成功率，减少并发症，缩短患者住院时间，从而增强患者坚持治疗的信心。
