Department of Urological Surgery, Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia.
Department of Surgery, School of Medicine, Deakin University, Geelong, Victoria, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1873-1878. doi: 10.1111/ans.17644. Epub 2022 Apr 3.
Minimally invasive insertion of catheters for peritoneal dialysis can be performed laparoscopically or percutaneously under image guidance. In Geelong (Victoria, Australia) both methods are used. Our aim was to analyse the outcomes of all catheters inserted by both laparoscopic and percutaneous techniques and compare them against published studies from tertiary referral centres.
Data were collected retrospectively on all patients who had their catheter inserted (since 2006) within the Geelong regional service. We compared the outcomes of percutaneous catheter insertion under image guidance (percutaneous group, n = 29) with the laparoscopic catheter placement technique (laparoscopic group, n = 61). Perioperative, follow-up and catheter outcome data were collected. There were no exclusion criteria. Analysis was performed using the unpaired student t-test and chi-squared test.
Ninety catheters were inserted between 2006 and 2017 in mostly male patients (63%) with a mean age of 60 ± 0.4 years. The most common aetiology of chronic kidney disease was diabetic nephropathy (34%). Percutaneous insertion required less operative time, shorter hospital stay and earlier initiation of peritoneal dialysis. In the longer term, percutaneous catheters were more likely to migrate and laparoscopic catheters were more durable but more often associated with peritonitis. Thirty-day complication rates did not differ between both groups. No Clavien-Dindo grade 3 or 4 complication was reported.
Laparoscopic insertion of peritoneal dialysis catheters at our centre is performed safely and with patient outcomes comparable to published literature. Percutaneous insertion represents a safe and effective alternative based on the study findings.
经皮或腹腔镜引导下微创置管行腹膜透析，在澳大利亚维多利亚州的吉隆市两种方法均有应用。本研究旨在分析所有经腹腔镜和经皮技术置管患者的结局，并与来自三级转诊中心的文献报道进行比较。
收集自 2006 年以来在吉隆地区服务中心接受置管的所有患者的回顾性数据。我们将经皮引导下置管（经皮组，n=29）与腹腔镜置管技术（腹腔镜组，n=61）的结果进行了比较。收集围手术期、随访和导管结局数据。无排除标准。采用独立样本 t 检验和卡方检验进行分析。
2006 年至 2017 年间共置管 90 例，患者均为男性（63%），平均年龄 60±0.4 岁。慢性肾脏病的最常见病因是糖尿病肾病（34%）。经皮置管操作时间更短、住院时间更短、更早开始腹膜透析。长期来看，经皮导管更易发生迁移，而腹腔镜导管更耐用，但更常并发腹膜炎。两组 30 天并发症发生率无差异。未发生 Clavien-Dindo 分级 3 或 4 级并发症。
本中心行腹腔镜置管腹膜透析安全有效，患者结局与文献报道相似。根据研究结果，经皮置管是一种安全有效的替代方法。
