Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Saint Louis, Missouri.
Pediatric Surgery, SSM Health Cardinal Glennon Children's Hospital, Saint Louis University School of Medicine, Saint Louis, Missouri.
J Surg Res. 2021 Aug;264:16-19. doi: 10.1016/j.jss.2020.12.065. Epub 2021 Mar 18.
Although literature is sparse, there are guidelines regarding optimal placement technique for peritoneal dialysis (PD) catheters in the pediatric population. Through this study, we sought to identify commonly used techniques among pediatric surgeons and identify areas for future work.
A 16-question anonymous survey was emailed to American Pediatric Surgery Association members in September 2018 regarding routine practices for PD catheter placement. Descriptive statistics and Fisher's exact test were used for analysis.
In all, there were 221 respondents, 6.8% of whom did not place PD catheters in their practice. Of the remaining 206, the majority have been in practice >15 y. PD catheter placement during fellowship training varied widely, with 6.5% reporting no fellowship experience to 6% reporting >25 placed during fellowship. Almost half (48%) reported placing catheters via laparoscopic approach (versus open or combined approach). Most (62%) respondents reported an annual practice volume of 1-5 catheters, with only 11% placing >10 per year. Exit-site sutures were placed "always" by 33% of participants and "never" by 49% of participants. There was no association between years in practice or fellowship experience and exit-site suture placement. However, there was a trend for "never" placement (72%) with more recent graduates. Omentectomy was performed by 91% of respondents, whereas 8.3% reported never performing omentectomy/omentopexy. Similarly, there was no association between practice and fellowship experience and omentectomy. In the setting of abdominal stoma, 96% reported placing the exit site on the opposite side of the abdomen. Fibrin glue was used along the tunnel by 21% of participants, ranging from "always" to "sometimes", whereas 79% "never" used it.
Fellowship, posttraining experience, and techniques in PD catheter placement vary widely among American Pediatric Surgery Association member respondents. Despite guidelines, practices differ among providers without an association between the number of cases performed in fellowship and postfellowship volume.
尽管文献资料稀少，但针对儿科人群的腹膜透析（peritoneal dialysis，PD）导管最佳置管技术已有相关指南。通过本研究，我们旨在确定小儿外科医师中常用的技术，并确定未来的工作领域。
2018 年 9 月，我们向美国小儿外科学会（American Pediatric Surgery Association）成员发送了一份关于 PD 导管置管常规实践的 16 个问题的匿名调查，以了解其相关情况。采用描述性统计和 Fisher 确切检验进行分析。
共 221 名受访者回复了该调查，其中 6.8%的受访者在其工作实践中未置 PD 导管。在其余 206 名受访者中，大多数人从业时间超过 15 年。在 fellowship 培训期间 PD 导管置管的情况差异较大，6.5%的受访者报告无 fellowship经历，6%的受访者报告在 fellowship期间置管超过 25 根。近一半（48%）的受访者报告通过腹腔镜方法（与开放或联合方法相比）置管。大多数（62%）受访者报告的年 PD 导管置管数量为 1-5 根，仅有 11%的受访者每年置管超过 10 根。33%的参与者始终在出口部位缝合缝线，而 49%的参与者从不缝合。从业年限或 fellowship经历与出口部位缝合缝线的放置之间没有关联。但是，最近的毕业生中更倾向于“从不”缝合缝线（72%）。91%的受访者行网膜切除术，而 8.3%的受访者从不行网膜切除术/网膜固定术。同样，网膜切除术的实践与 fellowship 经历之间也没有关联。在腹部造口的情况下，96%的受访者将出口部位置于腹部的对侧。21%的参与者沿隧道使用纤维蛋白胶，范围从“始终”到“有时”，而 79%的参与者“从不”使用纤维蛋白胶。
美国小儿外科学会成员的调查结果显示，小儿 PD 导管置管的 fellowship、培训后经验和技术差异很大。尽管有指南，但由于在 fellowship 和 fellowship 后实践中完成的病例数量之间没有关联，因此提供者的实践情况也存在差异。
