Sharma Manjuri, Singh Suresh, Doley Prodip K, Pegu Gayatri, Pegu Miranda
Nephrology, Gauhati Medical College, Guwahati, IND.
Cureus. 2025 Apr 28;17(4):e83113. doi: 10.7759/cureus.83113. eCollection 2025 Apr.
Background Continuous ambulatory peritoneal dialysis (CAPD) is a feasible and practical option for renal replacement therapy (RRT) in patients with end-stage renal disease (ESRD). However, the superiority of the surgical method versus the percutaneous method for peritoneal dialysis catheter (PDC) placement is not well established. Methods We retrospectively analyzed 91 peritoneal dialysis (PD) catheters inserted using two methods: the minilaparotomy technique performed by a surgeon (Group S, n=57) and the percutaneous technique performed by a nephrologist (Group N, n=34) over a 36-month study period. Results The primary PDC nonfunction rate was comparable between the two groups (3.5% vs. 3.3%). Catheter survival at one year (78.9% vs. 80%, p=0.761) and at the end of the study (61.4% vs. 66.6%, p=0.947) was higher in Group N but not statistically significant. The mean duration of catheter survival (in months) was identical in both groups (19.62±10.42 vs. 19.62±10.42), and patient survival at the end of the study was also comparable (78.9% vs. 80%, p=0.852). Peritonitis rates (per patient-year) did not differ significantly between the groups (0.15 vs. 0.10, p=0.693). Mechanical complication rates and refractory peritonitis rates were also comparable between the two groups. Conclusion The outcomes of percutaneously placed PDCs performed by a well-trained nephrologist were comparable to those placed by surgeons using the minilaparotomy technique. Training more nephrologists in percutaneous PDC insertion could enhance patient access and convenience in care.
背景 持续非卧床腹膜透析（CAPD）是终末期肾病（ESRD）患者肾脏替代治疗（RRT）的一种可行且实用的选择。然而，腹膜透析导管（PDC）置入的手术方法与经皮方法相比的优势尚未明确。方法 我们回顾性分析了在36个月的研究期间使用两种方法插入的91根腹膜透析（PD）导管：由外科医生进行的小切口剖腹术技术（S组，n = 57）和由肾病学家进行的经皮技术（N组，n = 34）。结果 两组的原发性PDC无功能率相当（3.5% 对 3.3%）。N组一年时（78.9% 对 80%，p = 0.761）和研究结束时（61.4% 对 66.6%，p = 0.947）的导管生存率较高，但无统计学意义。两组的导管平均生存时间（月）相同（19.62±10.42 对 19.62±10.42），研究结束时的患者生存率也相当（78.9% 对 80%，p = 0.852）。两组间腹膜炎发生率（每患者年）无显著差异（0.15 对 0.10，p = 0.693）。两组间机械并发症发生率和难治性腹膜炎发生率也相当。结论 由训练有素的肾病学家经皮置入PDC的结果与外科医生使用小切口剖腹术技术置入的结果相当。培训更多肾病学家进行经皮PDC置入可提高患者获得治疗的机会并增加护理的便利性。
