Copley J B, Lindberg J S, Back S N, Tapia N P
Department of Medicine, Ochsner Clinic, New Orleans, Louisiana 70121, USA.
Perit Dial Int. 1996;16 Suppl 1:S330-2.
Peritoneoscopic placement of peritoneal dialysis catheters, although accomplished in only about 10% of dialysis centers, is a nonsurgical technique that fulfills requirements for safety and dependability. Over a 40-month period, 136 catheters were placed with the peritoneoscope, 135 of which were double-cuffed, Swan neck curled catheters, with a uniform radiopaque stripe. Patients were followed longitudinally for outcome. Catheters were placed in 44 diabetic patients, 1 human immunodeficiency virus (HIV)-positive patient, and 18 morbidly obese patients. No complications occurred as a direct result of placement. Catheters were used, on average, nine days after placement (many on days 1 to 4) usually with 1.5 to 2 L exchanges. With 1183 patient-months' experience, complications were few: 28 patients experienced catheter-related infections, and there were five leaks that resolved with supine, low-volume dialysis for several days. Leakage did not correlate with time of usage after placement. Of ten outflow/mechanical problems that required catheter removal, nine involved catheter migration, probably due to lack of attention during placement to orientation of the radiopaque stripe. One was due to a preperitoneal placement early in this institution's experience with the peritoneoscope. Five of the migrated catheters were removed and then successfully replaced with the peritoneoscope at the same sitting. Four patients requested surgical removal and replacement. Sixteen catheters were removed because of catheter-related infections: five refractory Staphylococcus aureus, six Pseudomonas aeruginosa, two fungal, two Serratia species, and one Mycobacterium chelonei. Actuarial life-table analysis showed that at the end of the 40-month follow-up, 62% of the catheters were expected to survive. Because more than 50% survived, median catheter survival could not be calculated. The adverse responses were removal because of infection or catheter migration. Peritoneal dialysis catheter implantation with the peritoneoscope represents a safe and dependable method for catheter placement. Literature review and comparison indicate that catheter-related complications are fewer and catheter longevity is better with peritoneoscopic placement than with surgical placement. Our experience with prompt postplacement utilization suggests the need for further evaluation of catheter break-in procedure with the peritoneoscope.
经腹腔镜放置腹膜透析导管，尽管仅在约10%的透析中心开展，但这是一种满足安全性和可靠性要求的非手术技术。在40个月的时间里，使用腹腔镜放置了136根导管，其中135根是双套囊、鹅颈卷曲导管，带有均匀的不透X线条纹。对患者进行纵向随访以观察结果。导管放置于44例糖尿病患者、1例人类免疫缺陷病毒（HIV）阳性患者和18例病态肥胖患者体内。放置过程未直接导致并发症发生。导管放置后平均九天开始使用（许多在第1至4天），通常进行1.5至2升的液体交换。有1183个患者 - 月的经验，并发症较少：28例患者发生导管相关感染，有5例渗漏，通过数天的仰卧位、小容量透析得以解决。渗漏与放置后使用时间无关。在需要拔除导管的10例流出道/机械问题中，9例涉及导管移位，可能是由于放置过程中对不透X线条纹的方向缺乏关注。1例是由于该机构早期使用腹腔镜时发生的腹膜前置。5例移位导管被拔除，然后在同一次操作中通过腹腔镜成功更换。4例患者要求手术拔除并更换。16根导管因导管相关感染被拔除：5例为耐甲氧西林金黄色葡萄球菌感染，6例为铜绿假单胞菌感染，2例为真菌感染，2例为沙雷氏菌属感染，1例为龟分枝杆菌感染。精算生命表分析显示，在40个月的随访结束时，预计62%的导管可存活。由于超过50%的导管存活，无法计算导管的中位生存期。不良反应为因感染或导管移位而拔除。经腹腔镜植入腹膜透析导管是一种安全可靠的导管放置方法。文献回顾和比较表明，与手术放置相比，腹腔镜放置的导管相关并发症更少，导管使用寿命更长。我们对放置后迅速使用的经验表明，需要进一步评估腹腔镜导管磨合程序。
