Draganic B, James A, Booth M, Gani J S
Division of Surgery, John Hunter Hospital, Newcastle, New South Wales, Australia.
Aust N Z J Surg. 1998 Oct;68(10):735-9. doi: 10.1111/j.1445-2197.1998.tb04662.x.
Chronic ambulatory peritoneal dialysis (CAPD) is now an established technique for renal dialysis. Patients with renal failure cope poorly with major surgery and it is vital that the dialysis catheter tip is sited accurately in the pelvis if long-term catheter function is to be achieved. Laparoscopic placement of CAPD catheters may have potential advantages for renal patients by avoiding the morbidity of a laparotomy.
A retrospective audit was performed of all CAPD catheters inserted at the John Hunter Hospital over a 2-year period. Results of laparoscopically inserted catheters and those placed at laparotomy were compared.
Sixty catheters were inserted, 30 laparoscopically and 30 at laparotomy. The mean operative time was 41 min in the laparoscopic patients and 57 min in the laparotomy patients (P = 0.0001). The mean total dose of narcotic administered postoperatively was significantly less in the laparoscopic group (5 mg vs 65 mg, P = 0.00002). There were three minor peri-operative complications in the laparoscopic group and seven peri-operative complications in the laparotomy group, three required reoperation and one resulted in the patient's death. There were no significant differences in the incidence of exit-site infection, catheter blockage, peritonitis, and overall catheter survival, although the laparoscopically placed catheters had been followed up for a shorter period (10 vs 16 months).
This laparoscopic technique is safe and effective. Postoperative pain was less than for open placement. Laparoscopically placed catheters had a low incidence of peri-operative complications. Medium-term patency is similar to conventionally placed catheters. This procedure requires no additional equipment to that available for laparoscopic cholecystectomy and takes less time than the open operation.
慢性非卧床腹膜透析（CAPD）现已成为一种成熟的肾脏透析技术。肾衰竭患者对大手术的耐受性较差，若要实现透析导管的长期功能，将透析导管尖端准确置于盆腔至关重要。通过避免开腹手术的并发症，腹腔镜下放置CAPD导管对肾病患者可能具有潜在优势。
对约翰·亨特医院在两年内插入的所有CAPD导管进行回顾性审计。比较腹腔镜插入导管和开腹手术放置导管的结果。
共插入60根导管，30根通过腹腔镜插入，30根通过开腹手术放置。腹腔镜手术患者的平均手术时间为41分钟，开腹手术患者为57分钟（P = 0.0001）。腹腔镜组术后给予的麻醉剂平均总剂量明显较少（5毫克对65毫克，P = 0.00002）。腹腔镜组有3例轻微围手术期并发症，开腹手术组有7例围手术期并发症，3例需要再次手术，1例导致患者死亡。出口部位感染、导管堵塞、腹膜炎和导管总体生存率的发生率无显著差异，尽管腹腔镜放置的导管随访时间较短（10个月对16个月）。
这种腹腔镜技术安全有效。术后疼痛比开放放置时轻。腹腔镜放置的导管围手术期并发症发生率低。中期通畅率与传统放置的导管相似。该手术不需要比腹腔镜胆囊切除术更多的设备，且比开放手术耗时少。
