Smith Brandon M, Dan Adrian G
Department of Surgery, Summa Health Akron City Hospital, Akron, Ohio, USA.
Department of Surgery, Northeast Ohio Medical University, Rootstown, Ohio, USA.
J Laparoendosc Adv Surg Tech A. 2020 Jul;30(7):815-819. doi: 10.1089/lap.2019.0750. Epub 2020 Feb 19.
Peritoneal dialysis (PD) is an increasingly utilized treatment modality for renal replacement therapy that affords medical and lifestyle benefits to the patient and financial savings to the health care system. Successful long-term use of PD is reliant upon an optimally functioning catheter. Many potential catheter-related complications can be avoided through utilizing optimal placement technique. As widespread use of PD as a renal replacement modality continues to increase, the need for a safe, standardized, catheter placement technique has become more evident. To present a succinct synopsis of the rationale and elements of our current surgical management strategy for patients undergoing evaluation for PD and to provide a detailed stepwise description of our operative technique for PD catheter placement. This review describes potential pitfalls that may prevent optimal catheter function and describes each step taken to prevent potential complications. This description is combined with intraoperative photographs to highlight key steps. Following a defined reproducible stepwise approach, laparoscopic placement of continuous ambulatory peritoneal dialysis catheters can be performed safely and known potential complications hindering optimal catheter function can be addressed prophylactically.
腹膜透析(PD)是一种越来越多地用于肾脏替代治疗的方式,它为患者带来医疗和生活方式方面的益处,并为医疗保健系统节省费用。PD的长期成功使用依赖于功能最佳的导管。通过采用最佳放置技术,可以避免许多潜在的与导管相关的并发症。随着PD作为肾脏替代方式的广泛使用持续增加,对安全、标准化的导管放置技术的需求变得更加明显。 本文旨在简要概述我们目前对接受PD评估的患者进行手术管理策略的基本原理和要素,并详细逐步描述我们的PD导管放置手术技术。本综述描述了可能妨碍导管最佳功能的潜在陷阱,并描述了为预防潜在并发症所采取的每一步措施。此描述结合术中照片以突出关键步骤。按照定义的可重复的逐步方法,可以安全地进行腹腔镜持续非卧床腹膜透析导管放置,并可以预防性地解决妨碍导管最佳功能的已知潜在并发症。