Sia Yi, Hodgson Russell, Kuder Paula, Tog Chek
Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia.
Department of Surgery, University of Melbourne, Epping, Victoria, Australia.
ANZ J Surg. 2022 Nov;92(11):2990-2995. doi: 10.1111/ans.18002. Epub 2022 Aug 24.
Although peritoneal dialysis (PD) is a well-established and effective form of renal replacement therapy in end-stage renal failure (ESRF) patients, there is no consensus as to the optimal insertion technique. This study compares the outcomes of PD catheters inserted radiologically versus laparoscopically at a single centre.
Patients who underwent either radiological PD catheter insertion (RC) or laparoscopic insertion (LC) between 2013 and 2019 were retrospectively reviewed. Primary outcome was catheter patency at 12 months. Secondary outcomes included exit-site infections, peritonitis, and pericatheter leaks within 30 days of insertion, any complications associated with insertion, overall catheter survival, and inpatient length of stay (LoS).
There were 81 patients included in this study, with a total of 100 procedures performed (RC = 48, LC = 52). There were significantly fewer overall complications in the LC group compared to the RC group (P < 0.001). However, when individual complications were considered, this significant difference was only seen in the rate of malpositioned catheters (10.4% versus 0%, P = 0.023). Hospital LoS was longer in the LC group compared to the RC group (3 versus 2 days, P = 0.004), but this was outweighed by the fact that there were more laparoscopically inserted PD catheters still functioning and patent at 12 months compared to those inserted radiologically.
This study has demonstrated that our laparoscopic PD catheter insertion technique of securing the catheter tip low in the pelvis is safe and effective, providing a lower complication rate and longer-term viability when compared to the radiological percutaneous approach.
尽管腹膜透析（PD）是终末期肾衰竭（ESRF）患者中一种成熟且有效的肾脏替代治疗方式，但对于最佳置入技术尚无共识。本研究比较了在单一中心通过放射学方法与腹腔镜方法置入PD导管的结果。
回顾性分析2013年至2019年间接受放射学PD导管置入（RC）或腹腔镜置入（LC）的患者。主要结局是12个月时导管通畅情况。次要结局包括置入后30天内的出口处感染、腹膜炎、导管周围渗漏、与置入相关的任何并发症、导管总体生存率以及住院时间（LoS）。
本研究纳入81例患者，共进行了100例手术（RC = 48例，LC = 52例）。与RC组相比，LC组的总体并发症明显更少（P < 0.001）。然而，在考虑个体并发症时，这种显著差异仅见于导管位置不当的发生率（10.4%对0%，P = 0.023）。与RC组相比，LC组的住院时间更长（3天对2天，P = 0.004），但与放射学置入的PD导管相比，12个月时仍有更多腹腔镜置入的PD导管功能良好且通畅，这一事实抵消了住院时间长的影响。
本研究表明，我们在盆腔低位固定导管尖端的腹腔镜PD导管置入技术是安全有效的，与放射学经皮方法相比，并发症发生率更低且具有更长的长期生存能力。
