Dogra P M, Hooda A K, Shanmugraj G, Kumar S
Department of Nephrology, Command Hospital, Kolkata, West Bengal, India.
Department of Medicine, Command Hospital, Kolkata, West Bengal, India.
Indian J Nephrol. 2018 Jul-Aug;28(4):265-272. doi: 10.4103/ijn.IJN_281_17.
Surgical minilaparotomy technique of Tenckhoff catheter placement is rarely practiced by nephrologists. There is a scarcity of data comparing technique and outcomes of surgically inserted peritoneal dialysis catheters by surgeon and nephrologist. We retrospectively analyzed 105 Tenckhoff catheters inserted by surgical minilaparotomy ("S" [surgeon], = 43 and "N" [nephrologist], = 62) in end-stage renal disease. Comparative analysis of surgical technique, survivals, and complications between both groups was done. "N" group observed two major advantages; shorter break-in ( < 001) and early continuous ambulatory peritoneal dialysis rehabilitation. Cumulative catheter experience was 1749 catheter-months: 745 and 1004 catheter-months in "S" and "N" groups, respectively. "N" group had a better overall catheter and patient survival, and a statistically insignificant mechanical complications, seen mostly in obese and post-abdominal surgery patients, without fatality or catheter loss. Peritonitis rates ( = 0.21) and catheter removal due to refractory peritonitis ( = 0.81) were comparable. The technique used is practical and aids early break-in, yields better results, and later on, helps in easy and uncomplicated PDC removal as and when indicated. Mechanical complications, mostly bleeding, were managed conservatively without any catheter or patient loss. This method should be encouraged among nephrologists and nephrology residents.
肾内科医生很少采用手术小切口放置Tenckhoff导管的技术。目前缺乏关于外科医生和肾内科医生通过手术插入腹膜透析导管的技术及结果比较的数据。我们回顾性分析了105根通过手术小切口插入的Tenckhoff导管(“S”组[外科医生操作],n = 43;“N”组[肾内科医生操作],n = 62),这些导管用于终末期肾病患者。对两组的手术技术、导管存活情况及并发症进行了比较分析。“N”组有两个主要优势:透析开始时间较短(P < 0.01)和早期持续非卧床腹膜透析康复情况良好。导管累计使用时长为1749导管月:“S”组和“N”组分别为745导管月和1004导管月。“N”组的导管总体存活情况和患者存活情况更好,机械并发症在统计学上无显著差异,主要见于肥胖患者和腹部手术后患者,无死亡或导管丢失情况。腹膜炎发生率(P = 0.21)和因难治性腹膜炎导致的导管拔除率(P = 0.81)相当。所采用的技术实用,有助于早期透析开始,效果更好,并且在后续需要时有助于轻松、顺利地拔除腹膜透析导管。机械并发症主要是出血,通过保守治疗处理,无导管或患者丢失情况。应鼓励肾内科医生和肾内科住院医师采用这种方法。