Stegmayr B G
Department of Internal Medicine, University Hospital, Umeå, Sweden.
Perit Dial Int. 1993;13 Suppl 2:S124-6.
Starting peritoneal dialysis (PD) immediately after insertion of a peritoneal dialysis catheter is essential in some patients. However, due to a poor insertion technique, leakage may occur in up to 20% of patients after insertion of a peritoneal dialysis catheter, for example, in the midline. PD was started in 50 consecutive patients (age range 7-81 years). Under local anesthesia the Tenckhoff catheter was inserted about 3 cm lateral to the linea alba (mostly to the right) near the navel. The ventral and dorsal fasciae of the rectus muscle were split sagitally before entering the peritoneal membrane by a small incision. One purse-string suture fixed the peritoneal membrane around the inner cuff, while the second suture fixed the dorsal fascia of the rectus muscle around the outer side of the cuff. A third suture was placed around the catheter in the ventral fascia. Dialysis in all our patients was started peroperatively, initially by the use of 1 L of peritoneal dialysis fluid (Dianeal, Baxter Medical AB, Sweden). Bed rest for 2 or 3 days was requested of and performed by most patients. Only one early and no late leakages occurred. At reoperation of the patient with the leak, the second suture was found to have been loosened. The technique is easy to handle and enables immediate dialysis. The risk for leakage is very low.
对于某些患者而言，在插入腹膜透析导管后立即开始腹膜透析（PD）至关重要。然而，由于插入技术欠佳，高达20%的患者在插入腹膜透析导管后可能会发生渗漏，比如在中线部位。连续50例患者（年龄范围7至81岁）开始进行腹膜透析。在局部麻醉下，将Tenckhoff导管插入脐旁白线外侧约3厘米处（大多在右侧）。在通过一个小切口进入腹膜之前，纵向切开腹直肌的腹侧和背侧筋膜。一根荷包缝合线将腹膜固定在内套管周围，而第二根缝合线将腹直肌的背侧筋膜固定在套管外侧周围。第三根缝合线围绕导管置于腹侧筋膜处。我们所有患者均在手术过程中开始透析，最初使用1升腹膜透析液（百特医疗公司生产的Dianeal，瑞典）。大多数患者被要求并执行了2至3天的卧床休息。仅发生了1例早期渗漏，未发生晚期渗漏。在对发生渗漏的患者进行再次手术时，发现第二根缝合线已经松开。该技术易于操作，能够立即进行透析。渗漏风险非常低。
