Chong Chyi Chyi, Tan Tze-Woei, Abreo Kenneth, Pahilan Marie E, Rybin Denis, Doros Gheorghe, Zhang Wayne W, Farber Alik
Louisiana State University Health Shreveport, Shreveport, LA, and Boston University Medical Center, Boston, MA, USA.
Clin Nephrol. 2015 Mar;83(3):161-6. doi: 10.5414/cn108442.
The optimal method for placement of peritoneal dialysis catheters (PDC) is unclear. The objective of this study was to compare the outcomes of laparoscopic and open surgical placement of PDC.
Patients who underwent laparoscopic (LPD) and open (OPD) surgical placement of PDC between 2007 and 2011 were identified from the American College of Surgeons National Surgical Quality Initiative Project (NSQIP) dataset using current procedural terminology (CPT) and international classification of diseases 9th revision (ICD-9) codes. Perioperative outcomes were compared using Fisher's exact test for categorical variables, Student's t-test and Gamma regression were used for continuous variables. Catheter function was not reported in the dataset.
There were 1,560 PDC procedures in our study and most were performed laparoscopically (89%). 83% of these procedures were performed by general surgeons, mostly, with the patients under general anesthesia (95%). OPD was associated with a higher rate of perioperative deep organ infection (3.5% vs. 1.1%, p = 0.02) and need for reoperation (10.4% vs. 5.0%, p = 0.007). Operative time was, however, significantly longer with LPD (53.3 vs. 45.5 minutes, p < 0.001). In multivariate analysis, OPD was independently associated with increased risk of perioperative deep organ infection (odds ratio (OR) 3.7,95%, Confidence Interval (CI) 1.3 - 10.2, p = 0.01) and reoperation (OR 2.3, 95% CI 1.3 - 4.1, p = 0.005).
Laparoscopic PDC placement is more commonly performed and is associated with a lower risk of perioperative deep organ infection and reoperation than the open surgical approach. When possible, laparoscopic PDC placement might be preferable over open surgical placement.
腹膜透析导管（PDC）置入的最佳方法尚不清楚。本研究的目的是比较腹腔镜和开放手术置入PDC的结果。
利用当前手术操作术语（CPT）和国际疾病分类第9版（ICD-9）编码，从美国外科医师学会国家外科质量改进项目（NSQIP）数据集中识别出2007年至2011年间接受腹腔镜（LPD）和开放（OPD）手术置入PDC的患者。采用Fisher精确检验对分类变量进行围手术期结局比较，采用Student t检验和Gamma回归对连续变量进行比较。数据集中未报告导管功能。
本研究共进行了1560例PDC手术，其中大部分为腹腔镜手术（89%）。这些手术的83%由普通外科医生进行，大多数患者在全身麻醉下进行（95%）。OPD与围手术期深部器官感染率较高（3.5%对1.1%，p = 0.02）和再次手术需求较高（10.4%对5.0%，p = 0.007）相关。然而，LPD的手术时间明显更长（53.3对45.5分钟，p < 0.001）。在多变量分析中，OPD与围手术期深部器官感染风险增加（比值比（OR）3.7，95%置信区间（CI）1.3 - 10.2，p = 0.01）和再次手术（OR 2.3，95%CI 1.3 - 4.1，p = 0.005）独立相关。
腹腔镜PDC置入术比开放手术更常用，且围手术期深部器官感染和再次手术风险更低。在可能的情况下，腹腔镜PDC置入术可能比开放手术更可取。
