Qian Yue, Lin Haiping, Ye Qing, Yu Zanzhe, Qian Lijun, Ni Zhaohui, Gu Leyi, Fang Wei, Yan Hao
Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
Perit Dial Int. 2025 Apr 29:8968608251335831. doi: 10.1177/08968608251335831.
BackgroundPeritoneal dialysis (PD)-related pleuroperitoneal communication is strongly associated with PD discontinuation. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising therapeutic approach. However, there are still challenges in detecting diaphragmatic defects under conventional thoracoscopy, and the repair methods vary significantly.MethodsWe have developed an intervention protocol for pleuroperitoneal communication that includes single-port VATS utilizing near-infrared fluorescence with indocyanine green, as well as the management of perioperative kidney care and PD reinitiation. Patients who underwent VATS for pleuroperitoneal communication repair from September 2022 to March 2024 were identified at a single center. The procedures and outcomes were evaluated, and the success rate of PD resumption was compared with that of a historical cohort treated with non-surgical therapies.ResultsA total of 6 patients underwent VATS. The age was 48.7 ± 11.8 years, 2 were female, and the PD vintage was 8.7 (2.0-28.4) months. Non-dialysis therapy ( = 4) or temporary hemodialysis ( = 2) was prescribed during PD suspension. Fluorescence thoracoscopy identified diaphragmatic defects in all patients, including lesions that were unrecognizable under white light. Mechanical pleurodesis by direct suture of the defects with local mechanical reinforcement was performed. All patients reinitiated PD 15-30 days postoperatively, with no recurrence during a follow-up of 17.0 ± 6.4 months. The success rate significantly exceeded that in the patients who underwent PD suspension or chemical pleurodesis (100% vs. 29%, = 0.005).ConclusionsThe minimally invasive VATS integrating fluorescence with indocyanine green and pleurodesis with multiple mechanical reinforcements, along with appropriate perioperative care and an incremental approach to resume PD, was a reliable treatment for PD-related pleuroperitoneal communication.
背景
腹膜透析（PD）相关的胸膜腹膜交通与PD治疗中断密切相关。电视辅助胸腔镜手术（VATS）已成为一种有前景的治疗方法。然而，在传统胸腔镜检查下检测膈肌缺损仍存在挑战，且修复方法差异很大。
方法
我们制定了一种针对胸膜腹膜交通的干预方案，包括使用吲哚菁绿的近红外荧光单孔VATS，以及围手术期肾脏护理和重新开始PD的管理。在一个中心确定了2022年9月至2024年3月期间接受VATS进行胸膜腹膜交通修复的患者。评估了手术过程和结果，并将PD恢复成功率与接受非手术治疗的历史队列进行了比较。
结果
共有6例患者接受了VATS。年龄为48.7±11.8岁，2例为女性，PD病程为8.7（2.0 - 28.4）个月。PD暂停期间采用非透析治疗（n = 4）或临时血液透析（n = 2）。荧光胸腔镜检查在所有患者中均发现了膈肌缺损，包括在白光下无法识别的病变。通过直接缝合缺损并进行局部机械加固进行机械性胸膜固定术。所有患者术后15 - 30天重新开始PD，在17.0±6.4个月的随访期间无复发。成功率显著超过接受PD暂停或化学胸膜固定术的患者（100%对29%，P = 0.005）。
结论
将荧光与吲哚菁绿相结合以及采用多种机械加固的胸膜固定术的微创VATS，连同适当的围手术期护理和逐步恢复PD的方法，是治疗PD相关胸膜腹膜交通的可靠方法。
