中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (10): 653-655.doi: 10.3969/j.issn.1671-4091.2020.10.002

• 临床研究 • 上一篇    下一篇

改良经皮穿刺腹膜透析置管术在紧急起始腹膜透析中的应用

黄坚成1,边学燕1,包斯增1,罗春雷1,林晓琪1,戴丽丽1,张爱伟1   

  1. 1宁波市第一医院肾内科
  • 收稿日期:2020-03-09 修回日期:2020-07-15 出版日期:2020-10-12 发布日期:2020-10-12
  • 通讯作者: 边学燕 bianxueyan@medmail.com.cn E-mail:bianxueyan@medmail.com.cn
  • 基金资助:
    浙江省医药卫生科技项目(2019KY167)

Application of modified percutaneous technique of peritoneal dialysis catheter placement in urgent-start peritoneal dialysis patients 

  1. 1Department of Nephrology, Ningbo First Hospital, Ningbo 315000, China
  • Received:2020-03-09 Revised:2020-07-15 Online:2020-10-12 Published:2020-10-12

PDF

781

摘要： 【摘要】目的探讨改良经皮穿刺腹膜透析置管术在紧急起始腹膜透析中应用的安全性及有效性。方法选取76 例行腹膜透析的终末期肾脏病患者，分别采用改良经皮穿刺法(A 组34 例)和常规开腹手术法(B 组42 例)完成置管后开始紧急起始腹膜透析，对2 组患者的一般情况、原发病、手术时间、术后早期及远期并发症等进行对比分析。结果A 组在手术时间上短于B 组(t=-6.142，P=0.009)，术后早期渗漏的发生率、术后早期导管移位的发生率及术后远期导管移位的发生率均低于B 组(χ２值分别为8.341，7.523，11.724；P 值分别为0.001，0.003，＜0.001)，腹直肌出血发生率高于B 组(χ２ =5.272，P=0.018)；2 组在网膜包裹、腹膜炎、疝、胸腹瘘方面的差异无统计学意义(χ２值分别为0.659，0.091，0.148，0.148；P值分别为0.191，0.958，0.809，0.809)。结论在紧急起始腹膜透析中，改良经皮穿刺腹膜透析置管术是一种有效的、安全的、容易掌握的置管方式，与常规开腹手术法相比，手术时间更短，早期渗漏和导管移位的发生率低，值得临床推广。

关键词: 腹膜透析, 紧急起始, 经皮穿刺, 人工腹水, 腹直肌隧道

Abstract: 【Abstract】Objective This study assessed the efficacy and safety of the modified percutaneous peritoneal dialysis catheter placement in urgent-start peritoneal dialysis patients. Methods A total of 76 patients diagnosed as end-stage renal disease were enrolled, they were divided into group A (with modified percutaneous placement of peritoneal dialysis catheter,n=34)and groupB (with conventional placement of peritoneal dialysis catheter,n=42).The demographic and clinical characteristics,past abdominal operation history,surgery time,hospital stay after operation,early and late complications were observed. Results The operative time of group A was shorter than that of group B (t=-6.142，P=0.009)，the incidence of leakage in group A was lower than group B within one month (χ２=8.341，P=0.001)，the incidence of catheter displacement in group A was lower than group B within one month(χ２=7.523，P=0.003)，the incidence of rectus abdominis hemorrhage in group A was higher than group B (χ２=5.272，P=0.018); the incidence of catheter displacement in group A was lower than group B after one month (χ ２=11.724，＜0.001)，the incidences of omentum wrapping (χ ２=0.659，P=0.191), peritonitis (χ２=0.091，P=0.958), pleuro-abdominal fistula (χ２=0.148，P=0.809) and hernia (χ２=0.148，P=0.809) showed no difference between the two group. Conclusions The modified percutaneous placement of peritoneal dialysis catheter is effective, safe and easy to learn, which reduce leakage and catheter displacement significantly compared with conventional placement of peritoneal dialysis catheter, and worth clinical promotion in urgent-start peritoneal dialysis patients.

Key words: urgent start, peritoneal dialysis, percutaneous technique, artificial ascites, rectus sheath tunneling

中图分类号: