Brownlee J, Elkhairi S
Department of Surgery, Saint Luke's Medical Center, Cleveland, Ohio, USA.
Clin Nephrol. 1997 Feb;47(2):122-4.
Peritoneal dialysis catheters have been successfully placed via an open surgical technique, the percutaneous method, and the peritoneoscopic-assisted percutaneous methods. The latter two techniques produced lower complication rates, quicker use of the catheter, and longer functional survival, but also carried the risk of vascular and visceral injury during blind entry with a Varess needle or other penetrating instrumentation. A new technique is described which reduces the incidence of this iatrogenic complication and provides greater visualization of the peritoneal cavity. Using open laparoscopy as described by Hasson, a Tenckhoff catheter is placed in the peritoneal cavity and an adequate pneumoperitoneum is created. An operative laparoscope facilitates ideal visualization and distal catheter placement. A small separate incision is created for catheter exit.
Ten patients underwent placement or repositioning of the catheter with this new method. One patient experienced outflow obstruction subsequent to open surgical placement, necessitating repositioning.
The laparoscopic-assisted placement allows for thorough inspection of the peritoneal cavity and greater distal catheter inspection and placement, as well as reducing the risk of iatrogenic intra-abdominal visceral or vascular injury.
腹膜透析导管已通过开放手术技术、经皮方法以及腹腔镜辅助经皮方法成功置入。后两种技术并发症发生率较低、导管启用更快且功能存活期更长，但在使用Veress针或其他穿刺器械盲目穿刺时也存在血管和内脏损伤的风险。本文描述了一种新技术，该技术可降低这种医源性并发症的发生率，并能更清晰地观察腹膜腔。按照哈森描述的开放式腹腔镜检查方法，将Tenckhoff导管置入腹膜腔并建立足够的气腹。手术腹腔镜有助于实现理想的视野和导管远端放置。另外做一个小切口用于导管引出。
10例患者采用这种新方法进行导管置入或重新定位。1例患者在开放手术置入后出现流出道梗阻，需要重新定位。
腹腔镜辅助置入可对腹膜腔进行全面检查，更好地检查和放置导管远端，同时降低医源性腹腔内脏或血管损伤的风险。
