Wang Huiming, Wang Yujuan, Zhu Jili, Chen Xinghua, Chen Cheng, Xiang Cuizhi, Jia Houjun, Ding Guohua
Renal Department of Renmin Hospital, Wuhan University, Wuhan, China.
Division of General Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Artif Organs. 2018 Jul;42(7):728-735. doi: 10.1111/aor.13121. Epub 2018 Mar 30.
Percutaneous insertion of peritoneal dialysis catheters is theoretically most preferred by nephrologists because of the advantages of bedside performing, surgery independence, and minimal injury over other procedures of catheter placement such as open surgical dissection or laparoscopic operation. However, blindly placing catheters in the percutaneous procedure brings the risk of catheter malposition or bowel perforation; this largely retarded it's implementation. We had previously developed a novel technique termed "Wang's forceps-assisted catheter insertion and fixation," which had been successfully applied in the open surgical catheter insertion and displaced catheter reposition in our center. In this study, we further explored the possibility of applying the Wang's forceps in the procedure of percutaneous catheter insertion both in porcine model and patients with end stage renal disease (ESRD). A total of three miniature pigs successfully received percutaneous catheter insertion using Seldinger's technique with Wang's forceps assistance. The catheters were all placed in the right position and functioning well in dialysate drainage. This novel method of percutaneous catheter insertion was then performed on 20 ESRD patients. The procedure showed effective time-saving with the average operating time of 29.2 ± 3.53 min and was well tolerated by patients with minimal pain and injury. During a follow-up time of 6 months, no complications of catheter displacement, leakage, or blockade occurred. Our preliminary observation demonstrates that utilization of Wang's forceps in a percutaneous procedure conferred benefits of accurately placing and fixing catheters while preserving the merits of minimal invasion and simple performance.
经皮插入腹膜透析导管理论上是肾脏病学家最为青睐的方法，因为与其他置管方法（如开放手术解剖或腹腔镜手术）相比，它具有可在床边操作、无需手术以及损伤最小等优点。然而，在经皮操作中盲目置管会带来导管位置不当或肠穿孔的风险，这在很大程度上阻碍了该方法的实施。我们之前开发了一种名为“王氏钳辅助导管插入与固定”的新技术，该技术已在我们中心成功应用于开放手术导管插入及移位导管复位。在本研究中，我们进一步探讨了在猪模型和终末期肾病（ESRD）患者中应用王氏钳进行经皮导管插入的可能性。共有三只小型猪在王氏钳辅助下成功使用Seldinger技术进行了经皮导管插入。导管均放置在正确位置，透析液引流功能良好。然后，对20例ESRD患者实施了这种经皮导管插入的新方法。该操作显示出有效的省时效果，平均手术时间为29.2±3.53分钟，患者耐受性良好，疼痛和损伤最小。在6个月的随访期间，未发生导管移位、渗漏或堵塞等并发症。我们的初步观察表明，在经皮操作中使用王氏钳可在保持微创和操作简单优点的同时，带来准确放置和固定导管的益处。
