Kimmelstiel F M, Miller R E, Molinelli B M, Lorch J A
Department of Surgery, St. Luke's-Roosevelt Hospital Center, New York.
Surg Gynecol Obstet. 1993 Jun;176(6):565-70.
Laparoscopic surgical techniques were used for peritoneal dialysis catheter placement or for revision in patients with previous extensive abdominal surgical treatment, multiple prior catheter insertions or dysfunctional catheters with outflow obstruction. Nineteen laparoscopic procedures were performed upon 16 patients between July 1990 and January 1992. All patients were chosen for the laparoscopic approach because of the complicated nature of previous incisions or in an attempt to salvage existing catheters. In five patients, open laparoscopy was performed with the blunt Hasson trocar, and in the remaining patients, closed techniques were used to establish the pneumoperitoneum. Dysfunctional catheters were revised by adhesiolysis, partial omental resection and subtotal omentectomy. New catheters were easily placed percutaneously, sometimes after extensive adhesiolysis, using direct laparoscopic guidance. All patients had functioning catheters postoperatively. Two catheters subsequently failed because of dislodgement and recurrent obstruction. The overall success rate for the entire series was 75 percent. We conclude that laparoscopy will be a useful addition to the surgical armamentarium in managing patients on peritoneal dialysis, particularly as this mode of renal replacement therapy rapidly expands.
对于曾接受广泛腹部手术治疗、多次既往导管插入或存在流出道梗阻的功能不良导管的患者，采用腹腔镜手术技术进行腹膜透析导管置入或修复。1990年7月至1992年1月期间，对16例患者进行了19例腹腔镜手术。所有患者因既往切口复杂或试图挽救现有导管而选择腹腔镜手术入路。5例患者采用钝性哈森套管针进行开放式腹腔镜手术，其余患者采用闭合技术建立气腹。对功能不良的导管进行粘连松解、部分大网膜切除和次全大网膜切除术进行修复。在腹腔镜直接引导下，有时在广泛粘连松解后，新导管很容易经皮置入。所有患者术后导管功能良好。随后有2根导管因移位和反复梗阻而失败。整个系列的总体成功率为75%。我们得出结论，腹腔镜手术将成为腹膜透析患者手术治疗手段中的一项有用补充，尤其是在这种肾脏替代治疗模式迅速扩展的情况下。
