腹腔镜腹膜透析手术对曾接受腹部手术的患者安全有效。

Laparoscopic Peritoneal Dialysis Surgery is Safe and Effective in Patients with Prior Abdominal Surgery.

作者信息

Mohamed Ahmed, Bennett Mathew, Gomez Luis, Massingill Ethan, Le Linda, Peden Eric, Bechara Carlos F

机构信息

Department of Vascular Surgery, DeBakey Heart and Vascular Institute, The Houston Methodist Hospital, Houston, TX.

出版信息

Ann Vasc Surg. 2018 Nov;53:133-138. doi: 10.1016/j.avsg.2018.04.029. Epub 2018 Aug 7.

DOI:10.1016/j.avsg.2018.04.029

PMID:30012449

Abstract

BACKGROUND

Despite the lower cost, improved early survival, and preservation of the remaining kidney function, peritoneal dialysis is used by only 8.8% of the dialysis population in the USA. Intraabdominal adhesions reported in 70-90% of patients with prior abdominal surgery (PAS) reduce the peritoneal surface area and may increase the intraoperative and postoperative morbidity. The objective of this study is to evaluate the outcomes of laparoscopic peritoneal dialysis (LPD) catheter placement in patients with and without PAS.

METHODS

Patients who had LPD catheters placed between January 2014 and August 2016 were retrospectively reviewed. A Kaplan-Meier analysis was performed to assess the revision-free catheter survival (RFCS) and revision-assisted catheter survival (RACS) between the 2 groups.

RESULTS

One hundred forty-two patients had had LPD catheter placed during the study time, 82 (58%) with PAS. Lysis of adhesions (LOA) was required in 26 patients (28%) with PAS. Demographics and comorbidities were similar, but more women had PAS (65% vs. 35%, P < 0.001). Seventeen patients (12%) required revision, with no difference between the 2 groups. Both RFCS and RACS were similar in patients without and with PAS (P = 0.38 and 0.98, respectively). RFCS was 73% vs. 64% at 1 year (no PAS versus PAS) and 62% vs. 51% at 2 years, whereas RACS was 84% vs. 77% at 1 year (no PAS versus PAS) and 69% vs. 68% at 2 years. Only 2 intraoperative complications occurred, namely a superficial liver injury and pelvic hematoma. Three complications (0.02%) occurred within 30 days, namely 1 peritonitis and 2 catheter malfunctions. Overall complication rate was 25%, predominantly poor drainage (17% and 22% for PAS and no PAS, respectively), and there were no differences between the subgroups. No deaths occurred within a year of surgery during the study follow-up.

CONCLUSIONS

LPD and LOA can be performed safely in patients with multiple PAS. When possible, LPD catheters should be part of the vascular surgery training armamentarium and offered to patients with PAS.

摘要

背景

尽管腹膜透析成本较低、早期生存率提高且能保留残余肾功能，但在美国只有8.8%的透析人群使用腹膜透析。70%至90%有腹部手术史（PAS）的患者报告存在腹腔粘连，这会减少腹膜表面积，并可能增加术中和术后发病率。本研究的目的是评估有或无腹部手术史患者行腹腔镜腹膜透析（LPD）置管的结果。

方法

回顾性分析2014年1月至2016年8月期间行LPD置管的患者。进行Kaplan-Meier分析以评估两组之间的无导管翻修生存率（RFCS）和辅助导管翻修生存率（RACS）。

结果

在研究期间，142例患者行LPD置管，82例（58%）有腹部手术史。26例（28%）有腹部手术史的患者需要行粘连松解术（LOA）。人口统计学和合并症相似，但有腹部手术史的女性更多（65%对35%，P<0.001）。17例患者（12%）需要翻修，两组之间无差异。无腹部手术史和有腹部手术史患者的RFCS和RACS相似（分别为P=0.38和0.98）。1年时RFCS分别为73%对64%（无腹部手术史对有腹部手术史），2年时为62%对51%；而1年时RACS分别为84%对77%（无腹部手术史对有腹部手术史），2年时为69%对68%。仅发生2例术中并发症，即浅表性肝损伤和盆腔血肿。30天内发生3例并发症（0.02%），即1例腹膜炎和2例导管故障。总体并发症发生率为25%，主要是引流不畅（有腹部手术史和无腹部手术史患者分别为17%和22%），亚组之间无差异。在研究随访期间，手术1年内无死亡发生。