Chen Bin, Sun Chengbin, Zhou Jianbo, Li Li, Han Lina
Department of Kidney, Ningbo Zhenhai People's Hospital, Ningbo 315202, Zhejiang, China. Corresponding author: Chen Bin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1084-1087. doi: 10.3760/cma.j.cn121430-20210425-00608.
To observe the clinical effect of the cannula under laparoscopy, percutaneous puncture cannula, and conventional surgery cannula for peritoneal dialysis.
From May 3, 2015 to February 14, 2020, 87 patients with end-stage renal disease needing peritoneal dialysis in Ningbo Zhenhai People's Hospital were enrolled. These patients were divided into three groups including cannula under laparoscopy (23 cases), percutaneous puncture cannula (29 cases), and conventional surgery cannula (35 cases). The baseline characteristics, perioperative conditions (surgical time, post-surgical hospitalization time), the incidence of recent complications (abdominal hemorrhage, direct abdominal hemorrhage, incision pain, leakage, catheter shift, peritonitis), and long-term complications (catheter shift, peritonitis, hernia, thoracic and abdominal fistula, abdominal tube obstruction) among the three groups were compared.
Compared with the group of conventional surgery cannula, the operation time in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly shorter (minutes: 32.5±12.3, 28.9±11.8 vs. 61.3±15.4, both P < 0.05), the in-hospital stay in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were reduced (days: 9.8±3.4, 9.2±2.6 vs. 10.7±3.2), but there was no statistical significance among the three groups (P > 0.05). The incidence of abdominal bleeding, rectus abdominis bleeding, and incision pain in the group of cannula under laparoscopy and the group of percutaneous puncture cannula were significantly lower than those in the group of conventional surgery cannula [incidence of abdominal bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of rectus abdominis bleeding: 4.3% (1/23), 3.4% (1/29) vs. 22.9% (8/35), incidence of incision pain: 8.7% (2/23), 10.3% (3/29) vs. 42.9% (15/35), all P < 0.01]. The difference between the group of cannula under laparoscopy and the group of percutaneous puncture cannula had no statistical significance. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 27.6% (8/29), 31.4% (11/35), both P < 0.05]. Compared with the group of conventional surgery cannula and the group of percutaneous puncture cannula, the incidence of catheter displacement in long-term complications in the group of cannula under laparoscopy was significantly reduced [4.3% (1/23) vs. 24.1% (7/29), 31.4% (11/35), both P < 0.05], however, the difference of that between the group of conventional surgery cannula and the group of percutaneous puncture cannula was not statistically significant. The incidence of hernia in the group of cannula under laparoscopy was significantly higher than that in the group of percutaneous puncture cannula or in the group of conventional surgery cannula [21.7% (5/23) vs. 3.4% (1/29), 2.8% (1/35), both P < 0.05], and all of that were umbilical hernia, however, the difference of that between the group of percutaneous puncture cannula and the group of conventional surgery cannula was not statistically significant.
Compared with the traditional conventional surgical cannula placement methods, percutaneous puncture has the advantages of simple operation, short operation time, small trauma, but still cannot reduce the incidence of drift tube; laparoscopic peritoneal dialysis tube has the advantages of short operation time, small trauma and low catheter displacement rate, but increases the risk of umbilical hernia.
观察腹腔镜下套管置入、经皮穿刺套管置入及传统手术套管置入用于腹膜透析的临床效果。
选取2015年5月3日至2020年2月14日在宁波市镇海人民医院需行腹膜透析的87例终末期肾病患者。将这些患者分为三组，包括腹腔镜下套管置入组（23例）、经皮穿刺套管置入组（29例）和传统手术套管置入组（35例）。比较三组患者的基线特征、围手术期情况（手术时间、术后住院时间）、近期并发症（腹腔内出血、腹壁直接出血、切口疼痛、渗漏、导管移位、腹膜炎）及远期并发症（导管移位、腹膜炎、疝、胸腹瘘、腹透管堵塞）的发生率。
与传统手术套管置入组相比，腹腔镜下套管置入组和经皮穿刺套管置入组的手术时间明显缩短（分钟：32.5±12.3，28.9±11.8 对比 61.3±15.4，均P<0.05），腹腔镜下套管置入组和经皮穿刺套管置入组的住院时间缩短（天：9.8±3.4，9.2±2.6 对比 10.7±3.2），但三组间差异无统计学意义（P>0.05）。腹腔镜下套管置入组和经皮穿刺套管置入组的腹腔内出血、腹直肌出血及切口疼痛发生率明显低于传统手术套管置入组[腹腔内出血发生率：4.3%（1/23），3.4%（1/29）对比 22.9%（8/35），腹直肌出血发生率：4.3%（1/23），3.4%（1/29）对比 22.9%（8/35），切口疼痛发生率：8.7%（2/23），10.3%（3/29）对比 42.9%（15/35），均P<0.01]。腹腔镜下套管置入组与经皮穿刺套管置入组之间的差异无统计学意义。与传统手术套管置入组和经皮穿刺套管置入组相比，腹腔镜下套管置入组的导管移位发生率明显降低[4.3%（1/23）对比 27.6%（8/29），31.4%（11/35），均P<0.05]。与传统手术套管置入组和经皮穿刺套管置入组相比，腹腔镜下套管置入组远期并发症中导管移位发生率明显降低[4.3%（1/23）对比 24.1%（7/29），31.4%（11/35），均P<0.05]，然而，传统手术套管置入组与经皮穿刺套管置入组之间的差异无统计学意义。腹腔镜下套管置入组的疝发生率明显高于经皮穿刺套管置入组或传统手术套管置入组[21.7%（5/23）对比 3.4%（1/29），2.8%（1/35），均P<0.05]，且均为脐疝，然而，经皮穿刺套管置入组与传统手术套管置入组之间的差异无统计学意义。
与传统的传统手术套管置入方法相比，经皮穿刺具有操作简单、手术时间短、创伤小的优点，但仍不能降低导管漂移的发生率；腹腔镜腹膜透析管具有手术时间短、创伤小和导管移位率低的优点，但增加了脐疝的风险。
