Bircan Huseyin Yuce, Kulah Eyyup
Baskent University, Department of General Surgery, Istanbul, Turkey.
Baskent University, Department of Nephrology, Istanbul, Turkey.
Ther Apher Dial. 2016 Feb;20(1):66-72. doi: 10.1111/1744-9987.12377. Epub 2015 Dec 5.
The key to achieving adequate continuous ambulatory peritoneal dialysis (CAPD) is that a functioning catheter should enable unrestricted inflow and outflow of the dialysate liquid from the peritoneal cavity with an intact peritoneal membrane. Despite its advantages, complications, such as outflow obstruction, catheter-related infection, and dialysate leakage are still problematic. Various laparoscopic techniques for catheter placement have been investigated. The main purpose of this study was to compare the laparoscopic and open surgical peritoneal dialysis (PD) catheter insertion techniques in a retrospective manner according to catheter survival, complications and the safety of both techniques. The study included end stage renal disease patients in our hospital in whom a PD catheter was placed between 2007 and 2014. Patients were divided into two groups: the open technique (OT) group and the laparoscopic preperitoneal tunneling approach (LA) group. Extracted data included patient demographics, operative data, catheter-related complications and follow-up data. Sixty-nine patients were enrolled into the study. CAPD catheters were placed into 35 patients via LA and 34 via OT. We found that the LA group patients had better survival rates compared with the OT group, especially the long-term survivals. All of the CAPD-related complications, (peritonitis, malposition, outflow obstruction, leakage) were lower in the LA group. However, the peritonitis, malposition and groin hernia rates were also statistically significantly lower in the LA group. When compared with the published data, we recommend laparoscopic CAPD catheter placement with a preperitoneal tunneling technique. The technique is safe and offers a better outcome.
实现充分的持续性非卧床腹膜透析（CAPD）的关键在于，功能正常的导管应能使透析液在完整的腹膜的情况下不受限制地进出腹腔。尽管具有诸多优势，但诸如流出道梗阻、导管相关感染和透析液渗漏等并发症仍然是问题。人们已经研究了各种用于导管置入的腹腔镜技术。本研究的主要目的是通过回顾性研究，根据导管存活情况、并发症以及两种技术的安全性，比较腹腔镜和开放手术腹膜透析（PD）导管置入技术。该研究纳入了我院2007年至2014年间置入PD导管的终末期肾病患者。患者被分为两组：开放技术（OT）组和腹腔镜腹膜前隧道置入法（LA）组。提取的数据包括患者人口统计学资料、手术数据、导管相关并发症及随访数据。69例患者纳入研究。35例患者通过LA置入CAPD导管，34例通过OT置入。我们发现，与OT组相比，LA组患者的生存率更高，尤其是长期生存率。LA组中所有与CAPD相关的并发症（腹膜炎、位置异常、流出道梗阻、渗漏）发生率均较低。然而，LA组的腹膜炎、位置异常和腹股沟疝发生率在统计学上也显著较低。与已发表的数据相比，我们推荐采用腹腔镜腹膜前隧道置入技术进行CAPD导管置入。该技术安全且效果更佳。
