Jia Xiaolong, Huang Jiancheng, Xie Guohai, Yan Zejun, Ma Qi, Zhang Dongxu, Jiang Junhui, Bian Xueyan, Cheng Yue
Department of Urology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, #59 Liuting Avenue, Ningbo, 315010, Zhejiang Province, China.
Department of Nephrology, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, #59 Liuting Avenue, Ningbo, 315010, Zhejiang Province, China.
Int Urol Nephrol. 2021 Jun;53(6):1239-1245. doi: 10.1007/s11255-020-02769-4. Epub 2021 Jan 29.
Blind insertion limits the application of percutaneous peritoneal dialysis (PD) catheter placement. In this study, we first described the use of an optical puncture system in the PD catheter insertion, and investigated the feasibility and advantages of this modified technique.
This retrospective study included 65 patients with chronic kidney disease stage 5 (CKD5) who received ultrasound-guided percutaneous PD catheter insertion with or without optical puncture system assistance between June 2018 and July 2019. The patients' characteristics as well as the surgical outcomes and complications were compared between the modified group and the routine percutaneous insertion group.
Twenty-five patients underwent optical puncture system assistant insertion, whereas 40 patients received routine percutaneous insertion. More patients had previous abdominal surgical histories in the modified group than those in the routine group (24.0% vs. 5.0%, p = 0.047). The time of accessing to the abdominal cavity was significantly shorter in the modified group (median [IQR]; 1.1 min [0.8-1.3] vs. 5.0 min [4.0-6.0]; p < 0.001). Meanwhile, the time of the whole procedure was also significantly shorter in the modified group (median [IQR]; 26.0 min [25.0-29.0] vs. 33.0 min [29.0-35.0]; p < 0.001). None of the patient in the modified group, while two patients (5.0%) in the routine group converted to open procedure. There were no significant differences in the short and long postoperative complications between the two groups.
The operation of ultrasound-guided PD catheter placement with the optical puncture system is easy, safe, fast and accurate, whereby the PD catheter can be implanted percutaneously and visually under local anesthesia with minimal procedure-related complications. The visible puncture of the optical puncture system may facilitate ultrasound-guided percutaneous PD catheter insertion in patients with obesity and previous abdominal surgeries.
盲目插入限制了经皮腹膜透析（PD）导管置入术的应用。在本研究中，我们首次描述了光学穿刺系统在PD导管插入术中的应用，并探讨了这种改良技术的可行性和优势。
这项回顾性研究纳入了65例慢性肾脏病5期（CKD5）患者，这些患者在2018年6月至2019年7月期间接受了超声引导下经皮PD导管置入术，其中部分患者在光学穿刺系统辅助下进行，部分患者为常规经皮插入。比较改良组和常规经皮插入组患者的特征、手术结果及并发症。
25例患者接受了光学穿刺系统辅助插入，40例患者接受常规经皮插入。改良组有腹部手术史的患者比常规组更多（24.0%对5.0%，p = 0.047）。改良组进入腹腔的时间显著更短（中位数[四分位间距]；1.1分钟[0.8 - 1.3]对5.0分钟[4.0 - 6.0]；p < 0.001）。同时，改良组整个手术过程的时间也显著更短（中位数[四分位间距]；26.0分钟[25.0 - 29.0]对33.0分钟[29.0 - 35.0]；p < 0.001）。改良组无患者转为开放手术，而常规组有2例患者（5.0%）转为开放手术。两组术后近期和远期并发症无显著差异。
超声引导下使用光学穿刺系统进行PD导管置入术操作简便、安全、快速且准确，可在局部麻醉下经皮直视植入PD导管，与手术相关的并发症极少。光学穿刺系统的可视穿刺可能有助于肥胖及有腹部手术史患者的超声引导下经皮PD导管插入。
